Faculty Bibliography

BACKGROUND:Germline testing has an increasingly important role in prostate cancer care. However, a relative shortage of genetic counselors necessitates alternate strategies for delivery of pre-test education for germline testing. This study, funded by the Prostate Cancer Foundation, seeks to address the need for novel methods of delivery of pre-test germline education beyond traditional germline counseling to facilitate informed patient decision-making for germline testing. METHODS:This is a two-armed randomized controlled trial (RCT) with a target enrollment of 173 participants with prostate cancer per study arm (total anticipated n = 346). Patients who meet criteria for germline testing based on tumor features, family history or Ashkenazi Jewish ancestry are being recruited from 5 US sites including academic, private practice and Veterans healthcare settings. Consenting participants are randomized to the interactive pretest webtool or germline counseling with assessment of key patient-reported outcomes involved in informed decision-making for germline testing. RESULTS:Participants complete surveys at baseline, after pretest education/counseling, and following disclosure of germline results. The primary outcome of the study is decisional conflict for germline testing. Secondary outcomes include genetic knowledge, satisfaction, uptake of germline testing, and understanding of results. CONCLUSION/CONCLUSIONS:Our hypothesis is that the web-based genetic education tool is non-inferior to traditional genetic counseling regarding key patient-reported outcomes involved in informed decision-making for germline testing. If proven, the results would support deploying the webtool across various practice settings to facilitate pre-test genetic education for individuals with prostate cancer and developing collaborative care strategies with genetic counseling. CLINICALTRIALS/RESULTS:gov Identifier: NCT04447703.

BACKGROUND:Plant-based diets are increasingly popular and have many well-established benefits for health and environmental sustainability. Our objective was to perform a systematic review of plant-based diets and prostate cancer. METHODS:We performed a systematic database and citation search in February 2022. Studies were included if they reported primary data on plant-based dietary patterns (i.e., vegan, vegetarian, plant-based) and incidence among at-risk men for prostate cancer, or oncologic, general health/nutrition, or quality of life outcomes among patients with prostate cancer or caregivers. RESULTS:A total of 32 publications were eligible for the qualitative synthesis, representing 5 interventional and 11 observational studies. Interventional studies primarily focused on lifestyle modification including plant-based diets for men on active surveillance for localized prostate cancer or with biochemical recurrence after treatment, showing improvements in short-term oncologic outcomes alongside improvements in general health and nutrition. Observational studies primarily focused on prostate cancer risk, showing either protective or null associations for plant-based dietary patterns. Studies of the vegan diet consistently showed favorable associations with risk and/or outcomes. Gaps in the current literature include impact for long-term disease-specific outcomes. CONCLUSIONS:Interventional studies showed generally favorable results of lifestyle modifications incorporating a plant-based diet with prostate cancer outcomes as well as improvements in nutrition and general health. Observational studies demonstrated either a lower risk of prostate cancer or no significant difference. These results are encouraging in light of the many benefits of plant-based diets for overall health, as well as environmental sustainability and animal welfare.

Standardisation of hashtags for urologic diseases in the Urology Tag Ontology (UTO) project has facilitated more efficient filtering of social media content. Hashtags must be recognisable and easy to understand. The UTO list should be expanded to include hashtags for urologic procedures and the hashtags could be used on social media platforms other than Twitter to reach a wider audience.

Introduction: Prostate cancer diagnosis and treatment have a significant impact on sexual function and quality of life. Although prostate cancer is often called a "couples disease," there is limited research on the needs of partners who are affected by the patient's sexual dysfunction.
Objective(s): The objective of our study was to compare the sexual health concerns and unmet needs of patients with prostate cancer and partners using real-world data from an online prostate cancer community.
Method(s): We performed a mixed-methods analysis of data from the Inspire UsTOO Prostate Cancer Online Support & Discussion Community. This online health community about prostate cancer has more than 30,000 members, including both patients and partners. Through a data use agreement, we obtained anonymized text from public postings to the Sexual Health & Intimacy Forum on this community. Quantitative and qualitative data were examined from a random sample of 10% of the posts by women about sexual health (n=66), and were compared to an equal number of randomly selected posts by men.
Result(s): Among 6193 posts about sexual health and intimacy in prostate cancer, 661 (11%) were by female contributors. Of posts with cancer treatment details, surgery was the most common treatment discussed followed by hormonal therapy. Erectile dysfunction was the most common sexual complaint for both men and women. Posts by women were most likely to discuss problems with communication, relationship conflict, their partner's loss of libido, and the importance of intimacy. Common themes of the posts included coping with a "new normal" in their relationship, lack of access to and expense of erectile aids, and insufficient information and support from clinicians surrounding sexual recovery. A greater proportion of female posts conveyed emotion compared to male posts. The most common positive emotions were satisfaction and hope; while the most common negative emotions were frustration and loss of familiar sexual interaction. Although many posts discussed a variety of medical and surgical therapies for sexual recovery, very few discussed counseling or other psychosocial treatments.
Conclusion(s): Patients with prostate cancer and their partners experience a wide range of sexual health issues related to prostate cancer diagnosis and treatment. Online communities are widely used to give and receive peer-to-peer advice and support during sexual recovery. These findings highlight an unmet need for more extensive education and support surrounding sexual health for couples during the prostate cancer journey. Disclosure: No
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OBJECTIVE/BACKGROUND/OBJECTIVE:To examine the impact of prostate cancer (PCa) on sleep health for patients and caregivers. We hypothesized that sleep disturbances and poor sleep quality would be prevalent among patients with PCa and their caregivers. PATIENTS/METHODS/METHODS:A systematic literature search was conducted according to the Preferred Reporting Items for a Systematic Review and Meta-analysis guidelines. To be eligible for this systematic review, studies had to include: (1) patients diagnosed with PCa and/or their caregivers; and (2) objective or subjective data on sleep. 2431 articles were identified from the search. After duplicates were removed, 1577 abstracts were screened for eligibility, and 315 underwent full-text review. RESULTS AND CONCLUSIONS/CONCLUSIONS:Overall, 83 articles met inclusion criteria and were included in the qualitative synthesis. The majority of papers included patients with PCa (98%), who varied widely in their treatment stage. Only 3 studies reported on sleep among caregivers of patients with PCa. Most studies were designed to address a different issue and examined sleep as a secondary endpoint. Commonly used instruments included the Insomnia Severity Index and European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaires (EORTC-QLQ). Overall, patients with PCa reported a variety of sleep issues, including insomnia and general sleep difficulties. Both physical and psychological barriers to sleep are reported in this population. There was common use of hypnotic medications, yet few studies of behavioral interventions to improve sleep for patients with PCa or their caregivers. Many different sleep issues are reported by patients with PCa and caregivers with diverse sleep measurement methods and surveys. Future research may develop consensus on validated sleep assessment tools for use in PCa clinical care and research to promote facilitate comparison of sleep across PCa treatment stages. Also, future research is needed on behavioral interventions to improve sleep among this population.

BACKGROUND:Plant-based diets are associated with multiple health benefits and a favorable environmental impact. For prostate cancer, previous studies suggest a beneficial role of specific plant-based foods (e.g., tomatoes) and a potentially harmful role of specific animal-based foods (e.g., meat, dairy). However, less is known about plant-based dietary patterns. OBJECTIVES:We sought to examine the relation between plant-based diet indices and prostate cancer risk, including clinically relevant disease. METHODS:This was a prospective cohort study including 47,239 men in the Health Professionals Follow-Up Study (1986-2014). Overall and healthful plant-based diet indices were calculated from FFQs. Cox proportional hazards models were used to estimate HRs and 95% CIs to examine the risk of incident prostate cancer (total and by clinical category), among men ages <65 and ≥65 y. RESULTS:Of the 47,239 men, 6655 men were diagnosed with prostate cancer over follow-up, including 515 with advanced-stage disease at diagnosis, 956 with lethal disease (metastasis or death), and 806 prostate cancer deaths. Greater overall plant-based consumption was associated with a significantly lower risk of fatal prostate cancer (HR: 0.81; 95% CI: 0.64, 1.01; P-trend = 0.04). In men aged <65, a higher plant-based diet index was associated with a lower risk of advanced, lethal, and fatal prostate cancer. Moreover, greater consumption of a healthful plant-based diet was associated with lower risks of total (HR: 0.84; 95% CI: 0.73, 0.98; P-trend = 0.046) and lethal prostate cancer (HR: 0.56; 95% CI: 0.34, 0.94; P-trend = 0.03) at age <65. There were no associations between overall or healthful plant-based diet indices with prostate cancer among men ≥65 y. Fewer than 1% of participants followed a strict vegetarian or vegan diet. CONCLUSIONS:This prospective study provides supportive evidence that greater consumption of healthful plant-based foods is associated with a lower risk of aggressive forms of prostate cancer, with stronger benefit among men aged <65 y.

Background/UNASSIGNED:Although the Decipher genomic classifier has been validated as a prognostic tool for several prostate cancer endpoints, little is known about its role in assessing the risk of biopsy reclassification for patients on active surveillance, a key event that often triggers treatment. Objective/UNASSIGNED:To evaluate the association between Decipher genomic classifier scores and biopsy Gleason upgrading among patients on active surveillance. Design setting and participants/UNASSIGNED:This was a retrospective cohort study among patients with low- and favorable intermediate-risk prostate cancer on active surveillance who underwent biopsy-based Decipher testing as part of their clinical care. Outcome measurements and statistical analysis/UNASSIGNED:We evaluated the association between the Decipher score and any increase in biopsy Gleason grade group (GG) using univariable and multivariable logistic regression. We compared the area under the receiver operating characteristic curve (AUC) for models comprising baseline clinical variables with or without the Decipher score. Results and limitations/UNASSIGNED:= 0.02). The Decipher score was associated with upgrading among patients with biopsy GG 1 disease, but not GG2 disease. The discriminative ability of a clinical model (AUC 0.63, 95% CI 0.51-0.74) was improved by integration of the Decipher score (AUC 0.69, 95% CI 0.58-0.80). Conclusions/UNASSIGNED:The Decipher genomic classifier score was associated with short-term biopsy Gleason upgrading among patients on active surveillance. Patient summary/UNASSIGNED:The results from this study indicate that among patients with prostate cancer undergoing active surveillance, those with higher Decipher scores were more likely to have higher-grade disease found over time. These findings indicate that the Decipher test might be useful for guiding the intensity of monitoring during active surveillance, such as more frequent biopsy for patients with higher scores.

Introduction & Objectives: Gender composition within surgical academic leadership, including academic medical journals, disproportionately favors men. Disparities in journal leadership may introduce bias due to the familiar nature of reviewing and accepting academic publications. Genderrepresentation among academic urological journals' editorial boards has not yet been assessed. We evaluated female representation on editorialboards of urologic journals across multiple countries.Materials & Methods: Urologic journal leadership appointees' names and position descriptions were collected (from what pool? Did you surveyevery academic urology journal in the world?). Probable gender was obtained using gender-api.com or through personal title, as available. Journaleditorial positions were aggregated into broad leadership categories. Journal characteristics were summarized by Scimago Journal quartile (3 year,algorithmic weighted citation ranking) and geographic area. Chi-square test and multivariate logistic regression analysis were performed to assessfemale gender representation (p<0.05 significant).
Result(s): A total of 105 journals were reviewed with 5,991 total members: 877 (14.6%) female, 5,112 (85.3%) male and 2 (0.03%) non-binarypersons. Female representation significantly differed by leadership position, journal ranking, and geographic region. Editors-in-chief roles had thelowest female representation (48 females, 12.1%), while non-academic (32 females, 40.5%) and administrative (4 females, 80%) positions werehighest. Female representation, by journal ranking, was highest in Q1 (417 females, 19.4%) and lowest in Q3 (133 females, 8.9%) and by region,was highest in North American (323 females, 23.0%) and lowest in Asiatic region journals (55 females, 6.6%). On multivariate logistic regressionanalysis, Q1 journals had higher odds of female representation compared to Q2 and Q3. Additionally, compared to Western Europe, North Americanjournals had 78% higher odds and Asiatic journals had 50% lower odds of female representation (Fig 1).(Figure Presented)Conclusions: Female representation in urologic journal leadership is low across all journals, although trends in their proportion were identified by journal quartile and region. Addressing this gender imbalance may improve equal gender representation in journals and likely also improve female authored publication rates
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PURPOSE/OBJECTIVE:Black men have the highest incidence and mortality from prostate cancer (PCa) and lower quality of life compared to other U.S. racial groups. Additionally, more Latinx men are diagnosed with advanced disease and fewer receive guideline-concordant care. As many men seek medical information online, high-quality information targeting diverse populations may mitigate disparities. We examined racial/ethnic representation and information quality in online PCa content. MATERIALS AND METHODS/METHODS:We retrieved 150 websites and 150 videos about "prostate cancer" using the most widely used search engine (Google) and social network (YouTube). We assessed quality of health information, reading level, perceived race/ethnicity of people featured in the content and discussion of racial/ethnic disparities. RESULTS:Among 81 websites and 127 videos featuring people, 37% and 24% had perceived Black representation, and racial/ethnic disparities were discussed in 27% and 17%, respectively. Among 1,526 people featured, 9% and 1% were perceived as Black and Latinx, respectively. No content with Black or Latinx representation was high quality, understandable, actionable and at the recommended reading level. CONCLUSIONS:Black and Latinx adults are underrepresented in online PCa content. Online media have significant potential for public education and combating health disparities. However, most PCa content lacks diversity and is not readily understandable.

OBJECTIVES/OBJECTIVE:To perform a survey assessing the use of, attitudes towards, and perceived utility of social media (SoMe) in the 2021 urology residency match. METHODS:We distributed surveys to urology residency applicants and program directors (PDs) via the Urology Match 2021 Google Spreadsheet and email. The survey collected demographic information as well as SoMe activity, perceived pressure to use SoMe, match results, and attitudes regarding the utility of SoMe in the match process. RESULTS:A total of 108/528 (20%) applicants registered for the 2021 match and 61/142 (43%) PDs completed the survey. More applicants than PDs felt that SoMe helped them gain better insight into residency programs or applicants, respectively. Fewer applicants than PDs felt that SoMe activity provided a benefit to them in the match process. No significant relationship was found between SoMe viewing frequency, posting frequency, or tweetorial use with match outcomes. The majority of PDs believed that SoMe played a more important role in the 2021 match process than previous years while 15% and 12% reported that an applicant's SoMe activity helped or hurt the chances of matching to their program respectively. CONCLUSIONS:SoMe, particularly Twitter, was widely used in the 2021 match by both applicants and PDs. A majority of applicants and PDs believed that SoMe use aided them in some way in the match process, yet there was no relationship between the volume or type of applicant SoMe activity and match outcomes.