Faculty Bibliography

OBJECTIVE:To systematically review the literature on genomic tests for prostate cancer (PCa) and evaluate the current state of the evidence on their use in patients with newly diagnosed PCa. METHODS:We conducted a systematic review by searching PubMed, Embase, Cochrane Central, and conference abstracts from the American Urological Association published between 2010 and 2018. Studies evaluating Prolaris, Oncotype Dx, and Decipher assays were assessed for inclusion by two authors. Studies were excluded if the results were derived from surgical specimens rather than biopsy specimens. Meta-analysis was not performed owing to significant variations in methodologies, definitions and outcome measures. RESULTS:A total of 729 articles were retrieved in our initial search. After removing duplicates (270) and excluding articles deemed not relevant (432), 21 full-text articles were deemed suitable for inclusion in our analysis. The full-text articles comprised 8 studies on Prolaris, 8 studies on Oncotype Dx, and 5 studies on Decipher. For each genomic test we extracted data regarding the risk of adverse pathology, biochemical recurrence, metastasis, and prostate cancer mortality. CONCLUSION/CONCLUSIONS:The results of genomic tests that use biomarkers derived from prostate biopsy can be used in conjunction with clinicopathologic variables to improve our ability to risk stratify patients with newly diagnosed prostate cancer. Additional data are needed on the impact of using these tests on long-term patient outcomes and their cost-effectiveness. This article is protected by copyright. All rights reserved.

PURPOSE/OBJECTIVE:To define the role of focal laser ablation (FLA) as clinical treatment of prostate cancer (PCa) using the Delphi consensus method. METHODS:A panel of international experts in the field of focal therapy (FT) in PCa conducted a collaborative consensus project using the Delphi method. Experts were invited to online questionnaires focusing on patient selection and treatment of PCa with FLA during four subsequent rounds. After each round, outcomes were displayed, and questionnaires were modified based on the comments provided by panelists. Results were finalized and discussed during face-to-face meetings. RESULTS:Thirty-seven experts agreed to participate, and consensus was achieved on 39/43 topics. Clinically significant PCa (csPCa) was defined as any volume Grade Group 2 [Gleason score (GS) 3+4]. Focal therapy was specified as treatment of all csPCa and can be considered primary treatment as an alternative to radical treatment in carefully selected patients. In patients with intermediate-risk PCa (GS 3+4) as well as patients with MRI-visible and biopsy-confirmed local recurrence, FLA is optimal for targeted ablation of a specific magnetic resonance imaging (MRI)-visible focus. However, FLA should not be applied to candidates for active surveillance and close follow-up is required. Suitability for FLA is based on tumor volume, location to vital structures, GS, MRI-visibility, and biopsy confirmation. CONCLUSION/CONCLUSIONS:Focal laser ablation is a promising technique for treatment of clinically localized PCa and should ideally be performed within approved clinical trials. So far, only few studies have reported on FLA and further validation with longer follow-up is mandatory before widespread clinical implementation is justified.

Prostate cancer screening reduces advanced disease and prostate cancer death but is controversial due to downstream harms including unnecessary biopsies and overtreatment. In 2012 the United States Preventive Services Task Force (USPSTF) recommended against screening men for prostate cancer, a practice common since the early 1990's. This dramatic policy change was opposed by many physicians and patient groups. Our group reported on the Twitter response within 24 hours of these guidelines, showing a missed opportunity for greater advocacy since the majority of tweets did not express an opinion.

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.