Faculty Bibliography

PURPOSE/OBJECTIVE:North American studies have reported that ∼3-7% of opioid-naïve surgical patients transition to chronic opioid use after a single prescription. We examined the risk of chronic opioid use following radical prostatectomy (RP) using nationwide Swedish data. MATERIALS AND METHODS/METHODS:For 25,703 men in National Prostate Cancer Register of Sweden who underwent RP, linkage was performed to the Prescribed Drug Register. Opioid use was assessed in three time periods: baseline (13-1 month preoperatively), perioperative (1 month before and after), and postoperative (1-12 months). Multivariable logistic regression was used to identify predictors of new late use (≥1 opioid prescription in three consecutive months >2 months after surgery). RESULTS:Overall, 16,368 (64%) men filled an opioid prescription during the 13 months before or after surgery. Use of strong opioids increased over time and use of weak opioids decreased. 1.9% of men had opioid prescriptions during the baseline period, followed by a spike around surgery (59%), which sharply decreased in the second postoperative month. However, thereafter the proportion of men with opioid prescriptions remained slightly higher (2.2%) compared to the pre-RP baseline. Among chronic late users, 57% were previous users and 43% were new chronic users. Higher cancer risk category, greater comorbidity, unmarried status, and low educational level were associated with risk of new chronic opioid use. CONCLUSIONS:Slightly more than half of Swedish filled an opioid prescription after RP, and <1% became chronic opioid users. These rates are lower than previous studies of postoperative opioid use from North America.

BACKGROUND:Approximately 73% of US adults use YouTube, making it the most popular social media platform. Misinformation on social media is a growing concern; recent studies show a high proportion of misinformative health-related videos. Several studies on patient-provider communication and general health information seeking have been conducted. However, few studies to date have examined the potential association between patient-provider communication and health information seeking on specific social media platforms such as YouTube. A better understanding of this relationship may inform future health communication interventions. OBJECTIVE:The aim was to use nationally representative cross-sectional data to describe the association between perceived patient-provider communication quality and sociodemographic factors on watching YouTube health-related videos. METHODS:Data from the 2018 Health Information National Trends Survey were analyzed (N=3504). The primary outcome was whether participants watched a health-related video on YouTube over the past 12 months. A patient-provider communication composite score was created by summing responses about how often providers did the following: (1) gave you the chance to ask all the health-related questions you had, (2) gave attention to your feelings, (3) involved you in health care decisions as much as you wanted, (4) made sure that you understood the things you needed to do to take care of your health, (5) explained things in a way that you could understand, (6) spent enough time with you, and (7) helped you deal with feelings of uncertainty. Sociodemographic factors included age, gender, race/ethnicity, and education. Descriptive statistics and multivariable logistic regression were conducted. RESULTS:Approximately 1067 (35% weighted prevalence) participants reported watching a health-related video on YouTube. Higher perceived quality of patient-provider communication on the composite score was significantly associated with lower odds of watching health-related videos on YouTube. Regarding sociodemographic factors, increasing age and being a high school graduate (compared with college graduate) were associated with lower odds of watching health-related videos on YouTube; whereas, Hispanic and non-Hispanic Asians were more likely to have watched a health-related video on YouTube. For individual aspects of patient-physician communication, two of seven patient-provider communication variables were significant. Those who reported that providers "sometimes" spent enough time with them had higher odds of watching a health-related video on YouTube, compared with those who said providers "always" spent enough time with them. Participants reporting that they "never" have a chance to ask all their health-related questions also had higher odds of watching health-related videos on YouTube compared with those who reported "always." CONCLUSIONS:Higher perceived quality of patient-provider communication is associated with lower odds of watching health-related videos on YouTube. When providers do not spend enough time or give an opportunity to ask questions, patients are more likely to pursue health information on social media.

BACKGROUND/AIM/OBJECTIVE:National guidelines offer little guidance on the use of PSA progression (PSA increase as defined below) as a clinical endpoint in metastatic castration-resistant prostate cancer (mCRPC). The aim of the study was to examine treatment patterns/outcomes with abiraterone (abi)/enzalutamide (enza) throughout PSA progression and near the end of life (EOL). PATIENTS AND METHODS/METHODS:Cases of mCRPC treated with abi or enza from the New York Veterans Affairs (VA) from 6/2011-8/2017 were reviewed. Regression analyses were conducted to identify factors associated with continuation of abi/enza treatment up to the EOL, and survival. RESULTS:Of 184 patients, 72 received abi alone, 28 received enza alone, and 84 received both. Treatment was changed for PSA progression alone in 39.1% (abi) and 25.7% (enza) of patients. A total of 37 patients (20%) received abi/enza within 1 month before death, 30% of whom were receiving hospice services. Older patients and black patients were less likely to receive abi/enza up to the EOL. CONCLUSION/CONCLUSIONS:Abi/enza are frequently discontinued for PSA progression alone and continued at EOL. The clinical benefit of these practices warrants additional study.

YouTube is a social media platform with more than 1 billion users and >600000 videos about prostate cancer. Two small studies examined the quality of prostate cancer videos on YouTube, but did not use validated instruments, examine user interactions, or characterize the spread of misinformation. We performed the largest, most comprehensive examination of prostate cancer information on YouTube to date, including the first 150 videos on screening and treatment. We used the validated DISCERN quality criteria for consumer health information and the Patient Education Materials Assessment Tool, and compared results for user engagement. The videos in our sample had up to 1.3 million views (average 45223) and the overall quality of information was moderate. More videos described benefits (75%) than harms (53%), and only 50% promoted shared decision-making as recommended in current guidelines. Only 54% of the videos defined medical terms and few provided summaries or references. There was a significant negative correlation between scientific quality and viewer engagement (views/month p=0.004; thumbs up/views p=0.015). The comments section underneath some videos contained advertising and peer-to-peer medical advice. A total of 115 videos (77%) contained potentially misinformative and/or biased content within the video or comments section, with a total reach of >6 million viewers. PATIENT SUMMARY: Many popular YouTube videos about prostate cancer contained biased or poor-quality information. A greater number of views and thumbs up on YouTube does not mean that the information is trustworthy.

Introduction & Objectives: In the United States, there are more than 115 deaths per day from an overdose of opioids. Previous studies from the US have reported that approximately 5% of opioid-naive surgical patients become chronic opioid users after a single prescription postoperatively. The aim of our study was to examine the risk of chronic opioid use following radical prostatectomy (RP)in a different health care system. Material(s) and Method(s): We assessed filled prescriptions for opioids in 25,703 men in Prostate Cancer data Base Sweden (PCBaSe)[1]who had undergone retropubic or robot-assisted RP in 2007-2018. Opioid use was examined in three time periods: preoperative (13 months to 1 month before RP), perioperative (1 month before and 1 month after RP), and postoperative (1 to 12 months after RP). Multivariable logistic regression was used to assess the risk of transition to chronic opioid use, defined as one or more opioid prescription(s)in three consecutive months more than two months after surgery. Result(s): The median age at RP was 64 years and 86% of men had a Charlson comorbidity index of 0. A total of 1.9% of men had filled an opioid prescription in the preoperative period, followed by a spike in the perioperative period (59%), which sharply decreased in the second month. In the postoperative period, the percentage of men who had filled an opioid prescription was 2.3% (i.e 0.4% higher than in the preoperative period). Among chronic late users, 43% were new users. Unmarried status, low educational level, retropubic RP, high comorbidity, and more advanced risk category were predictors of transition to chronic use of opioids. Conclusion(s): Slightly more than half of Swedish men received opioid prescriptions surrounding radical prostatectomy. The absolute number of patients who became chronic opioid users after surgery was low. Socioeconomic status, comorbidity, cancer characteristics, and surgical approach were all associated with risk of becoming a new chronic user after radical prostatectomy.

Introduction & Objectives: Effective multifaceted dissemination and implementation are warranted for clinical practice guidelines to close the knowledge-to-action gap and promote guideline adherence. Digital media have transformed information exchange in the medical field, yet their potential for guideline dissemination has not been investigated yet. We aimed to perform a systematic review on digital dissemination strategies for clinical practice guidelines and to report from 4 years of experience within the @Uroweb #eauguidelines group. Material(s) and Method(s): We conducted the systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)guidelines searching both PubMed and the grey literature to identify articles on digital dissemination strategies for clinicalpractice guidelines. Using a step-wise approach, titles, abstracts and full texts were screened and assessed for inclusion according to pre-defined population, intervention, comparison, outcome, and study design (PICOS)criteria. Moreover, we collected outcome data for dissemination strategies employed by the EAU Guidelines Office Dissemination Committee. Result(s): After screening of 271 sources, 7 studies were included for qualitativenarrative synthesis. Dissemination strategies included internet-based e-learning interventions, interactive spaced education using email, abbreviated-teaching-tools, wireless technology enabling point-of-care guideline access and novel Social Media dissemination. The EAU Guidelines Office Dissemination Committee used the following strategies for multifaceted dissemination of guideline content (9-months-period): Twitter: #eauguidelines activity: 5,672 tweets by 1,522 participants leading to 11.2 million impressions. Facebook: 9 posts leading to 520 likes, 144 shares, 1,943 post clicks and a reach of 25,723. Instagram: 8 posts leading to 636 likes, 10,646 views and a reach of 6,589 unique visitors. Visual abstracts: 9 posts on Twitter and Facebook leading to a total reach >160,000. Homepage: 50% of uroweb.org traffic is guideline related. Conclusion(s): Reports on digital dissemination strategies for clinical practice guidelines are scarce and small-scale and include internet-based elearning interventions, interactive spaced education using email, abbreviated-teaching-tools, wireless technology enabling point-of-care guideline access and Social Media dissemination. Novel multifaceted digital dissemination strategies harnessing Twitter, Facebook, Instagram, Visual abstracts and web traffic lead to a high outreach and show potential for optimized dissemination of clinical practice guidelines.

PURPOSE/OBJECTIVE:Active surveillance (AS) for intermediate-risk prostate cancer (PCa) is controversial. Many AS programs are limited to grade group (GG) 1 (Gleason 6) and PSA<10 ng/ml. However, recent guidelines state that AS can be considered for limited GG2 (Gleason 3+4), despite limited data on outcomes. Our objective was to compare prostatectomy outcomes between subgroups of intermediate-risk versus low-risk PCa. METHODS:We performed an observational study in the National Prostate Cancer Register (NPCR) of Sweden, including 98% of PCa nationwide. From 2009-2012, 5087 men with low-risk (GG1, PSA<10, and ≤cT2) and intermediate-risk PCa (GG2 or PSA 10-20, or T2) underwent radical prostatectomy. We compared upgrading and upstaging between groups, based on the UCSF Cancer of the Prostate Risk Assessment (CAPRA) scores and published AS criteria. Results were validated in an independent dataset of cases diagnosed 2013-2016. RESULTS:Men with GG1, PSA 10-15ng/ml and PSA density <0.15 had no significant difference in upgrading and adverse pathology compared to low-risk PCa. PSA>15 or GG2 were associated with a significantly greater risk of aggressive PCa. Men with low-risk CAPRA scores (0-2) and GG2 had almost a 3-fold increased risk of upgrading and 2-fold increased risk of adverse pathology compared to low-risk CAPRA GG1. CONCLUSIONS:Expanding the PSA threshold to 15 ng/ml for GG1 PCa would allow more men to choose AS and is unlikely to compromise outcomes, particularly if PSA density is low. By contrast, caution should be exercised in offering AS to men with PSA>15 or GG2.

INTRODUCTION/BACKGROUND:According to current National Comprehensive Cancer Network guidelines, routine imagining for staging low-risk prostate cancer is not recommended. However, extensive overuse of guideline-discordant imaging continues to persist. Incidental findings are common on imaging and little is known about the optimal management. Rates of incidental findings vs. false positive diagnosis from inappropriate imaging are poorly understood and have yet to be quantified for low- and intermediate-risk prostate cancer patients. OBJECTIVE:To determine the frequency of positive radiologic findings in patients with low- and intermediate-risk prostate cancer during initial staging at VA New York Harbor Healthcare System. METHODS:We retrospectively reviewed all low- and intermediate-risk prostate cancer patients' medical records from the VA New York Harbor Healthcare System for diagnosis from 2005 to 2015. We reviewed each individual's prebiopsy prostate specific antigen (PSA), Gleason score, and clinical stage. We also determined if imaging obtained yielded a false positive, incidental finding, or if metastatic disease occurred within the 6 months following initial diagnosis. RESULTS:There were 414 men, who were classified as low- to intermediate-risk prostate cancer and underwent inappropriate staging imaging of 4,306 men diagnosed with prostate cancer. Of these 414 men, 178 (43%) had additional follow-up imaging for positive findings. We calculated an incidental finding rate of 10% and a false positive rate of 38% for patients. Five (1%) patients had metastatic disease. CONCLUSION/CONCLUSIONS:Despite guideline recommendations, imaging overuse remains an issue for low-intermediate-risk prostate cancer patients. The false positive rate found in this analysis is alarmingly high at 38%. This use of scans is burdensome to the healthcare system and patient. This study highlights the frequency of inappropriate imaging and its negative consequences.