Faculty Bibliography

OBJECTIVES/OBJECTIVE:To compare both the concordance between the 4Kscore® and SelectMDx® for informing decision to perform prostate biopsy (PB) and the performance of these tests for detecting clinically significant prostate cancer (csPCa). Several biomarkers were developed to inform decisions whether to perform a PB based on the probability of detecting csPCa. There is a paucity of studies directly comparing them METHODS: Between 11/2018 and 4/2019, all new referrals with the diagnosis of elevated PSA were advised to undergo 4Kscore® and SelectMDx® in order to guide the selection of candidates for PB. Men were advised to undergo PB if the reported biomarker risk for detecting csPCA was ≥7.5%, or if they presented a PI-RADS ≥1 MRI. Cohen's Kappa was used to assess the concordance between the binary 4Kscore® and SelectMDx® results using externally validated cutoffs of 7.5% and 12%. Receiver operating characteristics curve and area under the curve (AUC) assessed the performance of each biomarker for predicting csPCa. RESULTS:Of 128 consecutive patients referred, 114 (89.1%) underwent 4Kscore® and SelectMDx®, The kappa coefficient between the biomarkers using the 7.5% cutoff was 0.184 (poor concordance) and 0.22 using the 12% cutoff. The two biomarkers yielded discordant guidance whether to proceed with PB in 46% and 38% of cases, respectively. csPCa was found in 22 of the 50 patients who underwent PB (44%). The AUC for 4Kscore® and SelectMDx® was 0.830 (95%CI: 0.710 - 0.949) and 0.672 (95%CI: 0.517 - 0.828) (p=0.036), respectively. CONCLUSION/CONCLUSIONS:The discordance observed between the 4Kscore® and SelectMDx® is disconcerting. The 4Kscore® when combined with MRI was superior to the SelectMDx® for detecting csPCa. Prospective comparative studies must be performed to optimize implementation of biomarkers for selecting candidates for PB.

Current guidelines recommend conservative management as the preferred option for most low-risk prostate cancer cases, with certain possible exceptions (age <55yr, African Americans, and high-volume grade group 1). Although previous studies have documented substantial heterogeneity in the uptake of conservative management, less is known about the underlying reason for this variation and whether it is due to guideline-concordant factors (age, race, and biopsy cancer volume). We explored variation in the use of conservative management for low-risk prostate cancer among 20 597 men diagnosed in the US Veterans Affairs health care system from 2010 to 2016. Conservative management increased substantially over this time from 51% to 76% (p< 0.001). However, there was substantial variation by facility (35-100%). Multivariable analysis revealed that patient factors included in the guidelines (e.g., age and biopsy cores), other patient factors (eg, marital status and PSA) and non-patient factors (eg, geographic region, case volume, year) were associated with conservative management use. In conclusion, even within an integrated health care system, there remains significant heterogeneity in the uptake of conservative management for low-risk prostate cancer. Both guideline-concordant factors and other factors not discussed in the guidelines were associated with conservative management use. PATIENT SUMMARY: In the US Veterans Affairs health care system the vast majority of men with low-risk prostate cancer were managed conservatively by 2016, although there was significant variation by facility. Patient factors specifically mentioned in guidelines had the greatest impact on prediction of conservative management.

BACKGROUND:Prospective evidence supports active surveillance/watchful waiting (AS/WW) as an efficacious management option for low-risk prostate cancer that avoids potential treatment toxicity. AS/WW schedules require regular follow-up and adherence, and it is unknown to what extent patient socioeconomic status (SES) may impact management decisions for AS/WW. We sought to determine whether AS/WW use in the United States differs according to patient SES. DESIGN/METHODS:Using the Surveillance, Epidemiology, and End Results Prostate with AS/WW Database, all adult men diagnosed with localized low-risk prostate cancer (clinical T1-T2a, Gleason 6, and prostate-specific antigen <10 ng/mL) and managed with either AS/WW, radical prostatectomy, or radiotherapy were identified between 2010 and 2015. SES tertile was measured by the validated Yost Index (low: 0-10,901; middle: 10,904-11,469; high: 11,470-11,827). AS/WW trends were defined across SES tertiles from 2010 to 2015. Logistic multivariable regression defined adjusted odds ratios (aOR) for receipt of AS/WW by SES tertile. RESULTS:<0.001). By 2015, likelihood of AS/WW became comparable among the middle vs. high SES tertiles (aOR 0.96, 95% confidence interval (CI): 0.83-1.11, P = 0.55), but remained lower among the low vs. high SES tertile (aOR 0.73, 95% CI: 0.64-0.83, P < 0.001). CONCLUSIONS:AS/WW use for low-risk prostate cancer in the US differs by SES. Despite increases in AS/WW across SES from 2010 to 2015, patients from low SES received significantly lower rates of AS/WW compared with higher SES groups. SES may therefore influence management decisions, where factors associated with low SES might act as a barrier to AS/WW, and may need to be addressed to reduce any disproportionate risk of unnecessary treatment to lower SES patients.

Although there is a large amount of user-generated content about urological health issues on social media, much of this content has not been vetted for information accuracy. In this article, we review the literature on the quality and balance of information on urological health conditions on social networks. Across a wide range of benign and malignant urological conditions, studies show a substantial amount of commercial, biased and/or inaccurate information present on popular social networking sites. The healthcare community should take proactive steps to improve the quality of medical information on social networks. PATIENT SUMMARY: In this review, we examined the spread of misinformation about urological health conditions on social media. We found that a significant amount of the circulating information is commercial, biased or misinformative.

Introduction: Despite substantial evidence on the impact of prostate cancer treatment on sexual function and sexual quality of life for men, there is limited research on the effect that this has on the sexual quality of life of partners. A better understanding of partners' sexual concerns will enable support of mutuality in couples' sexual relationships in PCa survivorship.
Objective(s): To perform a content analysis of posts by female partners to an online prostate cancer community.
Method(s): Inspire is a web-based social platform containing numerous communities about different health topics, which patients and caregivers can use to share information and support. The Inspire UsTOO Prostate Cancer Online Support & Discussion Community is one of the many disease-specific communities, which currently has more than 20,000 members. Through a data use agreement, we obtained anonymized text from postings to the community by female caregivers. Posts were manually reviewed to identify content related to sexual health, and qualitative analysis was performed to identify key themes.
Result(s): There were many posts by women to the online prostate cancer community about sexual issues related to their partner's diagnosis and treatment. Table 1 shows key themes and sample quotes. Partners expressed that intimacy was more important than receptive intercourse, particularly during a stressful time dealing with a cancer diagnosis. Without intimacy, women expressed feelings of grief and isolation. Sexual health was also tied into women's evolving role as a caregiver, requiring time spent to plan ahead for sexual activity as well as research into management options to improve sexual function for their partner.
Conclusion(s): Data from online health communities provide a unique window into the lived experience of patients and their families. Sexual issues resulting from prostate cancer treatment have a significant impact on female partners. Lack of intimacy and changes in the sexual relationship can result in significant feelings of isolation and grief for female partners. [Formula presented] Disclosure: Work supported by industry: no.
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Previous epidemiologic studies have examined the relationship between sleep disturbances with prostate cancer (PCa) risk and/or survival. However, less has been published about the impact of sleep disturbance on quality of life for PCa survivors and their caregivers. Although PCa presents numerous potential barriers to sleep (e.g. hot flashes, nocturia), current survivorship guidelines do not address sleep. In addition to its impact on quality of life, sleep disturbances also mediate the impact of cancer status on missed days from work and healthcare expenditures.

Global usage of the social media (SoME) has increased exponentially. Facebook has close to 2.4 billion users, Twitter 330 million, YouTube 2 billion viewers each month, Instagram 1 billion active users, and LinkedIn 310 million users. This represents increases of 75%, 16%, 90%, 500%, and 19% respectively for these platforms over the past five years (1).

OBJECTIVE:To provide the first comprehensive analysis of the Twitter-verse amongst academic urologists and programs in North America. METHODS:Using national accreditation and individual program websites, all active urology residency programs (USA & Canada) and academic Urology faculty at these programs were identified. Demographic data for each program (AUA section, resident class size) and physician (title, fellowship training, Scopus H-index and citations) were documented. Twitter metrics (Twitter handle, date joined, # tweets, # followers, # following, likes) for programs and physicians were catalogued (data capture: March-April 2019). Descriptive analyses and temporal trends in Twitter utilization amongst programs and physician were assessed. Multivariable (MV) logistic regression was used to identify predictors of Twitter use. RESULTS:156 academic programs (143 USA, 13 Canada) and 2214 academic faculty (2015 USA, 199 Canada) were identified. Twitter utilization is currently 49.3% and 34.1% amongst programs and physicians, respectively, and continues to increase. On MV analysis, programs with 3-5 residents/year and programs with a higher percentage of faculty Twitter engagement were more likely to have Twitter accounts. From a physician perspective, those with fellowship training, lower academic rank (clinical instructor, assistant professor, associate professor vs. professor) and higher H-indices were more likely to have individual Twitter accounts. CONCLUSION/CONCLUSIONS:There is a steady increase in Twitter engagement amongst Urology programs and academic physicians. Faculty Twitter utilization is an important driver of program Twitter engagement. Twitter SoMe activity is strongly associated with academic productivity, and may in fact drive academic metrics. Within Urology, SoMe presence appears to be proportional to academic activity.