Faculty Bibliography

IMPORTANCE/UNASSIGNED:The US health care sector accounts for about 8.5% of national greenhouse gas (GHG) emissions. Reliable estimates of emissions associated with health care-related travel are essential for informing policy changes. OBJECTIVE/UNASSIGNED:To generate a comprehensive national estimate of carbon emissions due to patient health care-related travel in the US. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This cross-sectional study used data from the 2022 National Household Travel Survey (NHTS), conducted from January 2022 to January 2023. Participants were selected using an address-based sample from the US Postal Service Delivery Sequence File. Participating households reported all trips taken within 24 hours by all household members aged 5 years or older. Approximate emissions per mile were obtained from typical vehicle emissions data provided by US government institutions. Data were analyzed between March 11 and May 29, 2024. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Estimated annual CO2 equivalent (CO2e) emissions from patient health care-related travel per year, per patient, per trip, and per mile. A survey-weighted λ regression analysis was used to identify factors associated with higher CO2e emissions per trip. An alternative scenario analysis estimated reductions if 30% or 50% of private vehicle users switched to electric vehicles. RESULTS/UNASSIGNED:The sample included 16 997 participants with a weighted total of 3 506 325 536 US health care trips. Of these trips, 52.0% were reported by female travelers, 80.1% were made in urban areas, and 19.9% were made in rural areas. These trips accounted for 84 057 963 340 miles, resulting in weighted annual estimated emissions of 35.7 megatons (Mt) (95% CI, 27.5-43.9 Mt) CO2e. Each mile traveled generated an estimated 424 g (95% CI, 418-428 g) CO2e. Emissions per trip were higher (exponentiated coefficient [exp(β)], 2.19; 95% CI, 1.51-2.86; P < .001) for rural patients compared with urban patients. However, 69.3% of emissions were attributable to urban patients and 30.7% to rural patients. Patients with annual median household incomes of $50 000 to $99 999 generated higher trip emissions (exp[β], 1.92; 95% CI, 1.09-2.76; P = .003) compared with those with incomes of $25 000 or less. A 30% shift to electric vehicles was estimated to reduce health care-related carbon emissions to 27.6 Mt (95% CI, 20.7-34.6 Mt) CO2e, and a 50% shift was estimated to lower emissions to 22.3 Mt (95% CI, 16.0-28.6 Mt) CO2e. CONCLUSIONS AND RELEVANCE/UNASSIGNED:This cross-sectional study estimated that annual patient health care-related travel in the US generated 35.7 Mt CO2e, which accounts for a small but important proportion of total health care-related emissions in the US. These findings are essential for informing health care policy decisions and suggest that strategies such as telehealth and the adoption of electric vehicles may contribute to a small but significant reduction in health care-related GHG emissions.

BACKGROUND:Germline testing is important in prostate cancer and evaluation can be complex. METHODS:We instituted a monthly multi-disciplinary virtual genetics tumor board (7/2021-3/2022). Participants and panelists were surveyed on usefulness and acceptability. RESULTS:101 participants attended a session, and 77 follow-up surveys were completed. Over 90% participants and 100% panelists endorsed usefulness of the case discussions and usability of the technology. The majority felt it provided new information they will use. CONCLUSIONS:A multidisciplinary genetics board was successfully developed to address complexity in prostate cancer genetics. The virtual platform may enhance dissemination of expertise where there are regional gaps.

BACKGROUND AND OBJECTIVE/OBJECTIVE:As most Prostate Imaging Reporting and Data System (PI-RADS) 5 lesions on MRI harbor Gleason grade (GG) group ≥2 disease on biopsy, optimal management of patients with imaging-biopsy discordance remains unclear. To estimate grade misclassification, we evaluated the incidence of Gleason upgrading among patients with GG1 disease in the setting of a PI-RADS 5 lesion. METHODS:We conducted a single-institution retrospective analysis to identify patients with GG1 prostate cancer on fusion biopsy with MRI demonstrating ≥1 PI-RADS 5 lesion. Primary study outcome was identification of ≥GG2 disease on subsequent active surveillance (AS) biopsy or radical prostatectomy (RP). We used multivariable models to examine factors associated with reclassification. RESULTS:We identified 110 patients with GG1 disease on initial biopsy and ≥1 PI-RADS 5 lesion. There were 104 patients (94.6%) initially managed with AS and 6 (5.5%) received treatment. Sixty-one patients (58.7%) on AS underwent additional biopsies. Of these, 43 (70.5%) patients had tumor upgrading, with 32 (74.4%) upgraded on first surveillance biopsy. Forty-four (40%) patients ultimately received treatment, including prostatectomy in 15 (13.6%) and radiation in 25 (22.7%). Two patients (1.8%) developed metastases. In multivariable models, genomic classifier score was associated with upgrading. Limitations include a lack of multi-institutional data and long-term outcomes data. CONCLUSIONS:Most patients diagnosed with GG1 prostate cancer on MRI-Ultrasound fusion biopsy in the setting of a PI-RADS 5 lesion were found to have ≥GG2 disease on subsequent tissue sampling, suggesting substantial initial misclassification and reinforcing the need for confirmatory testing.

Much of the disease nomenclature used for patients with advanced prostate cancer has negative connotations and can be confusing or intimidating. Experts in the field convened to recommend a clearer and more accurate approach to defining the nomenclature.

BACKGROUND AND OBJECTIVE/OBJECTIVE:Innovations have improved outcomes in advanced prostate cancer (PC). Nonetheless, we continue to lack high-level evidence on a variety of topics that greatly impact daily practice. The 2024 Advanced Prostate Cancer Consensus Conference (APCCC) surveyed experts on key questions in clinical management in order to supplement evidence-based guidelines. Here we present voting results for questions from APCCC 2024. METHODS:Before the conference, a panel of 120 international PC experts used a modified Delphi process to develop 183 multiple-choice consensus questions on eight different topics. Before the conference, these questions were administered via a web-based survey to the voting panel members ("panellists"). KEY FINDINGS AND LIMITATIONS/UNASSIGNED:Consensus was a priori defined as ≥75% agreement, with strong consensus defined as ≥90% agreement. The voting results show varying degrees of consensus, as discussed in this article and detailed in the Supplementary material. These findings do not include a formal literature review or meta-analysis. CONCLUSIONS AND CLINICAL IMPLICATIONS/CONCLUSIONS:The voting results can help physicians and patients navigate controversial areas of clinical management for which high-level evidence is scant or conflicting. The findings can also help funders and policymakers in prioritising areas for future research. Diagnostic and treatment decisions should always be individualised on the basis of patient and cancer characteristics, and should incorporate current and emerging clinical evidence, guidelines, and logistic and economic factors. Enrolment in clinical trials is always strongly encouraged. Importantly, APCCC 2024 once again identified important gaps (areas of nonconsensus) that merit evaluation in specifically designed trials.

OBJECTIVE:In people with chronic kidney disease (CKD), hyperphosphatemia is a risk factor for mortality. Though unproven, dietary phosphorus control is considered essential in CKD. Although dietary and serum phosphorus are correlated, phosphorus from plant foods rich in phytate is less bioavailable than from animal and processed foods. Yogurt, valued for its low phosphorus and high protein, may be detrimental in CKD due to animal protein content. Plant-based yogurts (PBYs) might offer similar benefits without the downsides of animal protein, but little is known about their phosphorus content. DESIGN AND METHODS/METHODS:Protein contents and phosphorus additives were gathered from nutrition labels of several PBYs, including almond, cashew, oat, coconut, and soy substrates. Phosphorus content was measured via emission spectrometry by Eurofins (Madison, WI), and the phosphorus-to-protein ratio (PPR) was calculated for each PBY. RESULTS:Phosphorus content was highest in Silk Soy Strawberry, Silk Almond Strawberry, and Siggi's Coconut Mixed Berries, while it was lowest in So Delicious Coconut Strawberry, Oatly Oat Strawberry, Forager Cashew Strawberry, and Kite Hill Almond Strawberry. Ingredient labels revealed that Silk Soy Strawberry, Silk Almond Strawberry, and Oatly Oat Strawberry contained phosphorus additives, and Siggi's Coconut Mixed Berries contained pea protein additives. Though from the same substrate class, So Delicious Coconut Strawberry and Siggi's Coconut Mixed Berries showed significant differences in phosphorus and protein contents. All seven PBYs had higher PPR ratios than dairy yogurts like Stonyfield Organic Oikos Strawberry, Chobani Nonfat Strawberry, and Yoplait Greek Strawberry. CONCLUSION/CONCLUSIONS:Low-PPR foods are important for CKD patients. Siggi's Coconut Mixed Berries had the lowest PPR, making it potentially the most desirable for CKD patients. However, there is high variability in PPR among PBYs with the same substrate; therefore, Delicious Coconut Strawberry had the highest PPR, highlighting the importance of product selection for patients with CKD.

Telemedicine, virtual conferences, and reducing waste in the operating room are ways in which urologists can reduce their environmental impact in daily practice. Patient counseling should also consider advice that simultaneously promotes overall, urological, and planetary health, such as plant-based diets and active transport.

BACKGROUND AND OBJECTIVE/OBJECTIVE:Readability of patient education materials is of utmost importance to ensure understandability and dissemination of health care information in uro-oncology. We aimed to investigate the readability of the official patient education materials of the European Association of Urology (EAU) and American Urology Association (AUA). METHODS:Patient education materials for prostate, bladder, kidney, testicular, penile, and urethral cancers were retrieved from the respective organizations. Readability was assessed via the WebFX online tool for Flesch Kincaid Reading Ease Score (FRES) and for reading grade levels by Flesch Kincaid Grade Level (FKGL), Gunning Fog Score (GFS), Smog Index (SI), Coleman Liau Index (CLI), and Automated Readability Index (ARI). Layperson readability was defined as a FRES of ≥70 and with the other readability indexes <7 according to European Union recommendations. This study assessed only objective readability and no other metrics such as understandability. KEY FINDINGS AND LIMITATIONS/UNASSIGNED:Most patient education materials failed to meet the recommended threshold for laypersons. The mean readability for EAU patient education material was as follows: FRES 50.9 (standard error [SE]: 3.0), and FKGL, GFS, SI, CLI, and ARI all with scores ≥7. The mean readability for AUA patient material was as follows: FRES 64.0 (SE: 1.4), with all of FKGL, GFS, SI, and ARI scoring ≥7 readability. Only 13 out of 70 (18.6%) patient education materials' paragraphs met the readability requirements. The mean readability for bladder cancer patient education materials was the lowest, with a FRES of 36.7 (SE: 4.1). CONCLUSIONS AND CLINICAL IMPLICATIONS/CONCLUSIONS:Patient education materials from leading urological associations reveal readability levels beyond the recommended thresholds for laypersons and may not be understood easily by patients. There is a future need for more patient-friendly reading materials. PATIENT SUMMARY/RESULTS:This study checked whether health information about different cancers was easy to read. Most of it was too hard for patients to understand.