Faculty Bibliography

BACKGROUND:Potential rural-urban differences in prostate cancer care are understudied, particularly regarding the utilization of advanced diagnostic tests. Herein we examined variations in Positron Emission Tomography (PET) utilization for prostate cancer care, including diagnosis, staging and treatment planning, across residential regions in the United States. METHODS:Patients newly diagnosed with prostate cancer between 2019 and 2021 and post-diagnostic PETs were identified using full Medicare claims data. PET use was assessed in all newly diagnosed patients, though indications vary by risk. Patients' counties were categorized as metro, urban, or rural, from most to least urbanized. Regional PET utilization was further examined at the level of hospital referral regions. A multivariable logistic regression model was performed to assess the impact of rurality on PET imaging. A secondary analysis included an interaction term for race to explore the effect of residence on PET imaging by racial group. RESULTS:Overall, 495 865 patients were included in the analysis: 393 861 (79.4%) lived in metro, 56 698 (11.4%) in urban and 39 707 (8.0%) in rural counties. Patients in metro counties underwent PET imaging more often (8.4%) than patients in urban (7.3%) or rural counties (7.2%), p < 0.0001. At a level of hospital referral region, PET utilization rates ranged from 2.2 to 20.8%. PET imaging was more commonly performed in White compared to Black or Hispanic patients. Rural patients were less likely to undergo PET imaging compared to metro patients (odds ratio [OR] 0.87, 95% Confidence interval [CI]: 0.82-0.92 p < 0.0001). Rural Black (OR 0.69, 95%CI 0.57-0.83, p < 0.0001) and rural White patients (OR 0.89, 95%CI 0.83-0.94 p < 0.0001) were less likely to obtain PET imaging compared to their metro counterparts, p-interaction < 0.0001. CONCLUSION/CONCLUSIONS:Rural patients were less likely to undergo PET imaging than metro patients. The effect of rurality was most pronounced among Black patients. Our findings underscore the need for strategies to support equitable use of PET imaging.

BACKGROUND:Personalized therapeutic approaches for localized prostate cancer have evolved significantly, with tissue-based biomarker tests supplementing traditional risk stratification tools. However, national testing patterns and geographic variability remain limited a decade after coverage implementation. We aimed to assess current nationwide utilization and urban-rural differences in tissue-based biomarker testing. METHODS:Using full Medicare claims data, we retrospectively identified patients with newly diagnosed prostate cancer and tissue-based biomarker testing claims from 2019 to 2023. Patients' county of residence was categorized as metro, urban, or rural. Regional testing rates were further assessed across hospital referral regions. A multivariable logistic regression model was performed to assess the effect of residence on test receipt. RESULTS:Our final cohort included 749,202 patients, of whom 79.5% lived in metro, 11.4% in urban and 8.00% in rural counties. Overall, 86,908 (11.6%) patients underwent tissue-based biomarker tests. Hospital referral region-level testing rates ranged from 2.4% to 42.7%. Rural patients were 18% less likely to undergo testing compared to metro patients (Odds Ratio [OR] 0.82 95% Confidence Interval [CI] 0.73-0.91). Independently, the odds of undergoing testing were lower among Black (OR 0.82, 95% CI 0.77-0.88) and Hispanic patients (OR 0.80, 95% CI 0.73-0.88) compared to White patients. CONCLUSION/CONCLUSIONS:This study reveals high geographic variability in tissue-based biomarker testing for prostate cancer. Further, Black and Hispanic patients were less likely to receive testing. Our findings highlight regional practice variation in the use of advanced, not routinely recommended tests and underscore the need to minimize disparities in diagnostic access.

BACKGROUND/OBJECTIVES/OBJECTIVE:Patients often face uncertainty about what they should know after prostate cancer diagnosis. Web-based information is common but is at risk of being of poor quality or readability. SUBJECTS/METHODS/METHODS:We used ChatGPT, a freely available Artificial intelligence (AI) platform, to generate enquiries about prostate cancer that a newly diagnosed patient might ask and compared to Google search trends. Then, we evaluated ChatGPT responses to these questions for clinical appropriateness and quality using standardised tools. RESULTS:ChatGPT generates broad and representative questions, and provides understandable, clinically sound advice. CONCLUSIONS:AI can guide and empower patients after prostate cancer diagnosis through education. However, the limitations of the ChatGPT language-model must not be ignored and require further evaluation and optimisation in the healthcare field.

Germline Testing (GT) for prostate cancer (PCA) is now central to PCA care and hereditary cancer assessment, with a rising role in PCA screening approaches. Guidelines have significantly expanded to include testing patients with metastatic PCA, advanced PCA or with high-risk features, and for males with or without PCA with a strong family cancer history to identify hereditary cancer syndromes for patients and their families. However, the expansion of GT has overwhelmed genetic counselling programs, necessitating the development and evaluation of alternate genetic delivery models. Furthermore, disparities in engagement in PCA GT are of major concern for impacting PCA-related and overall cancer-related outcomes for patients and their families. This review focuses on integrating PCA GT guidelines with implementation strategies and addressing PCA GT disparities to help inform current and future strategies to enhance the benefits of GT across populations.

Despite several randomized controlled trials demonstrating the benefits of combination therapies for metastatic hormone-sensitive prostate cancer (mHSPC), a significant treatment gap persists. This initiative by the Prostate Cancer Foundation (PCF) convened stakeholders from academia, community practices, industry, and patient advocacy groups to address critical challenges in mHSPC care. Expert discussions and a review of real-world evidence and meta-analyses informed the development of strategies to improve care delivery. Evaluation of the data from global registries, such as IRONMAN, and large community databases was used to assess treatment utilization patterns and disparities. Combination therapies with two agents-androgen deprivation therapy (ADT) plus an androgen receptor pathway inhibitor (ARPI)-or three agents-ADT + ARPI + docetaxel-demonstrate significant survival improvements while preserving quality of life for patients with mHSPC, yet adoption remains inconsistent. Of the eligible patients, 20%-60% remain undertreated, with geographic, financial, and systemic barriers contributing to inconsistencies in care. Younger, White, urban-dwelling patients with fewer comorbidities are more likely to receive combination treatment, highlighting disparities across populations. Meta-analyses identified a lack of standardization due to varying inclusion criteria and comparators across trials. Real-world evidence underscored disparities influenced by geographic location, practice type, and access to specialty care. Initiatives such as the PANTHER study highlight improved outcomes in Black patients treated with combination therapies, emphasizing the importance of including diverse populations in clinical trials. To bridge gaps in care, this initiative prioritizes awareness, standardization, and equitable access to evidence-based therapies. Proposed solutions include targeted knowledge dissemination strategies, development of educational resources, and advocacy for policy changes to promote guideline-concordant care. By leveraging collaborative efforts, organizations, including PCF, can contribute to enhancing survival outcomes and quality of life for all patients with mHSPC.

PURPOSE OF REVIEW/OBJECTIVE:Artificial intelligence (AI) chatbots are increasingly used as a source of information. Our objective was to review the literature on their use for patient education in urology. RECENT FINDINGS/RESULTS:There are many published studies examining the quality of AI chatbots, most commonly ChatGPT. In many studies, responses from chatbots had acceptable accuracy but were written at a difficult reading level without specific prompts to enhance readability. A few studies have examined AI chatbots for other types of patient education, such as creating lay summaries of research publications or generating handouts. SUMMARY/CONCLUSIONS:Artificial intelligence chatbots may provide an adjunctive source of patient education in the future, particularly if prompted to provide results with better readability. In addition, they may be used to rapidly generate lay research summaries, leaflets or other patient education materials for final review by experts.

Urological diseases and their varied forms of management warrant special attention in the setting of climate change. Regarding urological cancers, climate change will probably increase the incidence and severity of cancer diagnoses through exposures to certain environmental risk factors, while simultaneously disrupting cancer care delivery and downstream outcomes. Regarding benign urological diseases, a burgeoning body of work exists on climate-related heat waves, dehydration, urolithiasis, renal injury and infectious and vector-borne diseases. Adding to the potential effect on disease pathogenesis, many patients with urological diseases undergo high-tech, resource-intensive interventions, such as robotic surgery, and entail intensive longitudinal assessments over many years. These features incur a considerable carbon footprint, generate substantial waste, and can introduce vulnerabilities to climate-related weather events. Links exist between planetary health (the health of humans and the natural systems that support our health), climate change and urological disease and urological care providers face many challenges in the era of anthropogenic climate change. The next steps and priorities for research, management, and health care delivery include identification and prioritization of health care delivery strategies to minimize waste and carbon emissions, while supporting climate resilience. Examples include supporting telemedicine, limiting low-value care, and building resilience to minimize impacts of climate-related disasters to prepare for the challenges ahead.

BACKGROUND:Prostate cancer (PCa) diagnosis and treatment can have a significant negative impact on sexual health, affecting patients and their partners; however, the impact on partners is insufficiently addressed in current practice. OBJECTIVE:We describe the development and validation of an instrument to measure sexual health in female partners of patients with PCa. DESIGN, SETTING, AND PARTICIPANTS/METHODS:Questions assessing sexual health were developed through a literature review, two qualitative studies, and an expert consensus process. Candidate survey items were tested through cognitive interviews and used to iteratively refine the questionnaire. INTERVENTION/METHODS:The final questionnaire was tested in a validation study among 200 female partners. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS/METHODS:We performed an exploratory factor analysis, followed by an analysis for internal validity, test-retest reliability, and convergent and discriminant validity. RESULTS AND LIMITATIONS/CONCLUSIONS:An initial set of 32 items was developed and refined through cognitive interviews. The resulting 27-item questionnaire was tested among 200 female partners of patients with PCa from across the USA. The exploratory factor analysis eliminated eight items and revealed seven key factors: (1) distress/satisfaction, (2) loss of connection as a couple, (3) active communication, (4) discomfort with communication, (5) frustration with sexual counseling, (6) expansion of sexual repertoire, and (7) nonpenetrative sexual activity. The overall scale demonstrated strong internal consistency (ordinal alpha 0.94) and test-retest reliability (0.89). Strengths of the study include development and evaluation of the first questionnaire to evaluate sexual quality of life among female partners of patients with PCa. However, additional work is needed to assess sexual health and quality of life among male and nonbinary partners. CONCLUSIONS:We developed a new instrument, the Sexual Concerns In Partners of Patients with Prostate cancer (SCIPPP-F), and found it to be valid in a diverse sample of female partners across the USA. PATIENT SUMMARY/RESULTS:Our new instrument can be used to characterize sexual health among female partners of patients with prostate cancer.

Plant-based diets have grown in popularity owing to multiple health and environmental benefits. Some evidence suggests that plant-based diets are associated with benefits for urological health. In genitourinary oncology, most research has focused on prostate cancer. Clinical trial results suggest a favourable influence of healthy lifestyle modifications including plant-based diets before and after prostate cancer treatment. Epidemiological evidence shows that a diet higher in plant-based and lower in animal-based food is associated with a lower risk of aggressive prostate cancer and better quality-of-life scores than a diet with less plant-based and more animal-based food. Studies on bladder and kidney cancer are scarce, but limited data suggest that vegetarian or plant-forward dietary patterns (increased consumption of fruits and vegetables and minimizing meat) are associated with a lower risk of development of these cancers than dietary patterns with fewer fruits and vegetables and more meat. With respect to benign urological conditions, epidemiological studies suggest that plant-based dietary patterns are associated with a lower risk of benign prostatic hyperplasia and urinary tract infections than non-plant-based dietary patterns. Compared with diets high in animal-based foods and low in plant-based foods, a substantial body of epidemiological evidence also suggests that increased consumption of healthy plant-based food is associated with a lower risk of erectile dysfunction. Plant-based dietary patterns that are high in fruits and vegetables with normal calcium intake, while limiting animal protein and salt, are associated with a lower risk of kidney stone development than dietary patterns that do not follow these parameters. Overall, increasing consumption of plant-based foods and reducing intake of animal-based foods has favourable associations with multiple urological conditions.