Faculty Bibliography

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: 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.

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.

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.

The cost of cancer care is a major concern, with one in 6 cancer patients reporting high to overwhelming levels of financial distress.[1] Crowd-funding has emerged as a new way of raising money from a large number of people, with >$34 billion raised in 2015.[2] Little is known the use of crowd-funding for common cancers, such as prostate and breast cancer.

CONTEXT/BACKGROUND:Social media (SoMe) has transformed communication among health care professionals by enabling rapid and global information exchange. Yet, the novelty of SoMe and concerns about potential risks continue to be barriers to adoption. OBJECTIVE:To encourage appropriate professional use of SoMe by physicians in concordance with best practices and to update practical guidelines for effective and professional use of these communication technologies. EVIDENCE AQUISITION/UNASSIGNED:The European Association of Urology (EAU; @Uroweb) brought together a committee of SoMe stakeholders in the urology field. PubMed and the grey literature were searched to identify SoMe position papers by other medical societies and organizations. EVIDENCE SYNTHESIS/RESULTS:Updated practical guidelines for effective and professional use of SoMe communication technologies. A core of 10 practical recommendations for the responsible, ethical, and constructive use of SoMe communication technologies was articulated. The guidelines are limited by their inherent subjective nature and lack of robust evidence supporting their utility. CONCLUSIONS:SoMe is reshaping the way the urological care providers communicate; however, appropriate engagement requires courtesy, professionalism, and honesty. Adherence to guidelines will help users harness the benefits of SoMe in a safe and effective manner. PATIENT SUMMARY/UNASSIGNED:Social media has transformed communication among health care professionals. This narrative review article provides an update of practical guidelines for effective and professional use of these communication technologies.