Faculty Bibliography

BACKGROUND:Innovations have improved outcomes in high-risk localised, locally advanced, and biochemically recurrent prostate cancer (PC), yet high-level evidence remains limited for many management decisions. The 2026 Advanced Prostate Cancer Consensus Conference (APCCC) surveyed an international panel on key clinical questions to complement evidence-based guidelines. OBJECTIVE:Here we present the voting results for the questions on high-risk localised, locally advanced, and biochemically recurrent PC from APCCC 2026. DESIGN, SETTING, AND PARTICIPANTS/METHODS:Before the conference, a multidisciplinary panel of 144 international PC experts used a modified Delphi process to develop 313 multiple-choice consensus questions, of which 134 covered high-risk localised and locally advanced PC, including prostate-specific antigen (PSA) persistence and PSA recurrence, and side effects of treatment. These questions were administered to the 133 voting panel members "panellists" via a web-based survey prior to the conference. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS/METHODS:Consensus was defined a priori as ≥75% agreement, with strong consensus defined as ≥90% agreement. Overall, consensus was reached for 44 of the 134 questions (32.8%), with seven questions reaching a strong consensus. Results and limitations The voting results show varying degrees of consensus, as discussed in this article and as detailed in the Supplementary Material. An interactive heat map for the questions can be found at https://apccc.org/APCCC2026-votings-localised-and-locally-advanced-prostate-cancer/. These findings do not include a formal literature review or meta-analysis. CONCLUSIONS:The voting results can help physicians and patients navigate controversial areas of clinical management for which evidence is scant or conflicting. The findings can also help funders and policymakers in prioritising areas for future research. Importantly, APCCC 2026 once again identified important gaps (areas of no consensus) that merit evaluation in specifically designed trials.

BACKGROUND:Despite the importance of germline genetic evaluation in prostate cancer (PCa), fewer U.S. Hispanic patients receive it. METHODS:We conducted semi-structured in-depth interviews with U.S. Hispanic patients with PCa in English or Spanish on facilitators and barriers to germline genetic testing. RESULTS:Barriers and facilitators were multidimensional. Key facilitators include family benefit, actionability, trust in clinicians, bilingual educational materials and insurance coverage; whereas key barriers include confusion with other tests, fear of negative implications, low awareness and limited clinician-led counseling. CONCLUSIONS:Bilingual informational materials, public messaging, and greater clinician education are needed to promote equity in PCa genetic evaluation.

BACKGROUND:Tissue-based gene expression assays provide prognostic information in prostate cancer, but their influence on decisions regarding immediate treatment versus conservative management, including active surveillance (AS) and watchful waiting (WW), remains uncertain. METHODS:Using a linkage with the Surveillance, Epidemiology, and End Results program, we evaluated the association between a 22-gene genomic classifier (GC) and initial management among patients with low or intermediate clinical-risk prostate cancer diagnosed from 2015 through 2018. Initial management was classified as immediate therapy or AS/WW, and GC scores were grouped as low (<0.45), intermediate (0.45-0.60), or high (>0.60). Multivariable logistic regression assessed associations between GC category and immediate treatment, stratified by clinical-risk group and adjusted for demographic and clinical covariates. RESULTS:Among 2,547 patients, 286 of 1,030 (27.8%) with low- and 1,113 of 1,517 (73.4%) with intermediate clinical-risk prostate cancer received initial treatment. Use of initial treatment increased with higher GC category. Among patients with low and intermediate clinical-risk prostate cancer, respectively, 20.5% and 57.5% with low GC, 28.3% and 75.8% with intermediate GC, and 46.2% and 88.3% with high GC scores received initial treatment. Higher GC category was independently associated with greater odds of immediate treatment versus AS/WW (versus low GC: intermediate GC, odds ratio [OR] 1.98, 95% confidence interval [CI] 1.57-2.49, p < 0.001; high GC, OR 4.42, 95% CI 3.41-5.71, p < 0.001). CONCLUSIONS:Higher GC scores were associated with greater use of immediate treatment and less use of AS/WW, underscoring the need to determine whether GC testing also predicts long-term outcomes among patients managed with AS.

IMPORTANCE:There are 3.5 million prostate cancer survivors in the US, with a need for evidence-based lifestyle recommendations that improve survivorship. OBJECTIVE:To assess whether consumption of specific dietary fats after diagnosis is associated with long-term survival among patients with nonmetastatic prostate cancer. DESIGN, SETTING, AND PARTICIPANTS:This study, nested in the Health Professionals Follow-Up Study, a cohort of male health professionals from across 50 US states ongoing since 1986, included participants with confirmed nonmetastatic prostate cancer between 1986 and January 2019, followed up through December 2022. Statistical analysis was conducted from July 2024 to May 2026. EXPOSURES:Dietary data were collected every 4 years from validated food frequency questionnaires and used to estimate intake of saturated, polyunsaturated, monounsaturated, trans, plant, and animal fat after cancer diagnosis. MAIN OUTCOMES AND MEASURES:Main outcomes were all-cause mortality and death from prostate cancer, other cancers, cardiovascular disease, and other causes during a median 12.8 years (IQR, 8.1-16.8 years) of follow-up through 2022. Hazard ratios (HRs) and 95% CIs from multivariable Cox proportional hazards regression and multivariate nutrient-density models examined associations with mortality, adjusting for demographic, epidemiologic, and clinical factors. RESULTS:Among 4884 patients with nonmetastatic prostate cancer, the mean (SD) age at diagnosis was 69.5 (6.9) years. During follow-up, 3040 deaths from any cause were confirmed. When comparing patients in the highest quintile of saturated fat consumption with those in the lowest quintile, higher postdiagnostic saturated fat intake was associated with greater all-cause (HR, 1.24 [95% CI, 1.05-1.47), cardiovascular (HR, 1.42 [95% CI, 1.02-1.98]), and other cancer mortality (HR, 1.42 [95% CI, 0.93-2.17]). Animal fat, a major source of saturated fats, was also positively associated with all-cause mortality (HR, 1.14 [95% CI, 0.97-1.33]), as well as deaths from other cancers (HR, 1.49 [95% CI, 1.00-2.21]). Replacing 10% of calories from animal fats with plant-based fats (HR, 0.84 [95% CI, 0.76-0.93]) and replacing 5% of calories from saturated fats with monounsaturated fats (HR, 0.80 [95% CI, 0.70-0.91]) was associated with a decrease in all-cause mortality. There were no associations between dietary fats and prostate cancer mortality. CONCLUSIONS AND RELEVANCE:In this cohort study of patients with nonmetastatic prostate cancer, saturated fats, including animal fats, were associated with greater all-cause mortality owing to deaths from cardiovascular disease and other cancers. Diets rich in monounsaturated and polyunsaturated fats and plant-based fats after prostate cancer diagnosis were associated with improved survival outcomes for patients. These findings support evidence-based recommendations for patients and clinicians around dietary fat consumption to improve survivorship outcomes in the clinical setting of nonmetastatic prostate cancer.

BACKGROUND:For over a decade the Advanced Prostate Cancer Consensus Conference (APCCC) covers a variety of topics that greatly impact daily practice. In 2025, a dedicated event was organised to discuss key questions in clinical management of patients with prostate cancer (PC) related to diagnostic tools (APCCC Diagnostics). Here we present the voting results of the APCCC Diagnostics questions. OBJECTIVE; DESIGN, SETTING, AND PARTECIPANTS: APCCC Diagnostics 2025 is a pilot project. The scientific committee for APCCC Diagnostics 2025 developed 88 multiple-choice consensus questions on six different topics. Prior to the conference, the panel members (''panellists'') voted on these questions via a web-based survey. Consensus was defined as ≥75% agreement, with strong consensus defined as ≥90% agreement. OUTCOMES MEASUREMENTS AND STATISTICAL ANALYSIS/METHODS:Consensus was only reached on 17 of 88 questions (19%), of which six (7%) received a strong consensus. Specifically, consensus was reached for two of 17 questions (14%) in "how to diagnose PC"; seven of 16 (44%) in "how to stage PC"; three of 14 (21%) in "Biochemical Recurrence Scenario"; two of 11 (18%) in "metastatic disease: what to do?"; zero of 18 (0%) in "monitoring metastatic PC"; and three of 12 (25%) in "radioligand therapy and imaging." CONCLUSIONS:The voting results and their discussion may assist physicians in navigating controversial areas of clinical management related to diagnosis, staging, and restaging in the different clinical settings for PC, particularly where high-level evidence is scarce or conflicting. The findings can also help funders and policymakers in prioritising areas for future research.

BACKGROUND:There are limited studies on telehealth use patterns among patients with prostate cancer. OBJECTIVE:We assessed the patterns of delivery of care for prostate cancer management in the Veterans Health Administration (VHA). DESIGN/METHODS:A retrospective observational cohort study from January 2016 to February 2023. PARTICIPANTS/METHODS:Data were from the VHA's Corporate Data Warehouse (CDW). Veterans with a new diagnosis of prostate cancer were included in the study. Those who died within 1 year of diagnosis, had missing staging information, or had no prostate-specific antigen (PSA), biopsy, or treatment recorded within 2 years of initial diagnosis were excluded. MAIN MEASURES/METHODS:Veterans were categorized into watchful waiting, active surveillance, and active treatment management groups based on subsequent care received and categorized into National Comprehensive Cancer Network (NCCN) risk categories. We categorized outpatient urology or oncology visits as telephone-based, video-based, or in-person using administrative stop codes. We used logistic regression models to evaluate the characteristics associated with at least one video/virtual visit. KEY RESULTS/RESULTS:In total, 60,381 Veterans were included in the study (20.3% low risk, 49.8% intermediate risk, and 29.8% high risk). Even during the COVID-19 pandemic, less than 6% and 9% of Veterans had at least one urology or oncology video visit, respectively, in the first year after diagnosis across all management groups. In the regression model, Veterans aged 60 and older were less likely to have video visits for both urology and oncology. In contrast, living in urban areas, being diagnosed during the COVID-19 pandemic, and being in the intermediate NCCN risk group were associated with higher odds of having at least one video visit in both specialties. CONCLUSIONS:Despite improvements in telehealth use among Veterans with prostate cancer, telehealth utilization, particularly video visits, remains low, warranting attention from leadership and policymakers.

Current guidelines for clinically localized prostate cancer offer a wide range of management options, from active surveillance to surgery and radiation therapy (RT). Treatment selection depends on tumor characteristics, overall health, and patient goals. Advances in surgical and radiation techniques have improved survival and functional outcomes, yet treatment continues to have significant impacts on quality of life. Sexual, urinary, and bowel dysfunction are common, and psychological distress, including anxiety, depression, and decisional regret, frequently accompany survivorship. Patients must navigate complex trade-offs between disease control and functional or personal outcomes. This review explores the interplay between treatment options, functional outcomes, and psychosocial considerations in localized prostate cancer care. Key topics include patient priorities, surgical strategies to optimize functional outcomes of radical prostatectomy, advances in RT which improve precision and reduce toxicity, and the role of mental health and lifestyle in survivorship. Integrating these approaches into multidisciplinary care can support overall quality of life. Aligning treatment decisions with patient values and goals is essential for reducing decisional regret and supporting patients through the complex and deeply personal decisions inherent in localized prostate cancer management.

ObjectiveWe designed a survey to determine the prevalence of sexual dysfunction among cancer patients and to understand the gaps in provider-patient communication.MethodsAn IRB-approved 36-item survey was distributed through the Jefferson Recruitment Enhancement Service team and social media. Questions assessed the impact of cancer treatment on sexual health, provider communication, how sexual health was assessed, and possible interventions. Chi-square test or Fisher's exact test were used to compare the group differences with a P-value threshold (α) of 0.05 for statistical significance.Results916 patients responded to the survey, with most being diagnosed with breast (n = 271, 29.6%) and prostate cancer (n = 358, 39.1%). 71.8% of patients experienced an impact on sexual function by cancer treatment. Most experienced issues with their sexual desire, body image, arousal, comfort during intercourse, and ability to achieve orgasm (α < 0.001). Only 35.5% reported being asked about their sexual health by an oncologist and only 22.2% were given a questionnaire to assess their sexual health (α < 0.001). 49.8% of breast patients and 15.4% of prostate patients were never told their sexual health could be affected by their cancer treatment (α < 0.001). 60.3% of prostate patients were formally asked about their sexual health by an oncologist compared to 21.4% of breast patients (α < 0.001). 74% of respondents stated it is essential for oncologists to speak to patients about sexual health.ConclusionCancer survivors believe it is important for providers to discuss sexual health. However, providers are more inclined to address sexual health concerns with male patients than with female counterparts.