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Comparison of patients with bladder cancer who underwent robot-assisted or open RC in the iROC trial and the open cohort from the 2019 to 2020 NSQIP targeted cystectomy database. Abbreviations CORAL Cystectomy Open Robotic and Laparoscopic iROC robot-assisted RC with intracorporeal urinary diversion vs open RC trial NSQIP National Surgical Quality Improvement Program RAZOR Randomised Open versus Robotic Cystectomy RC radical cystectomy Urologists have widely accepted a robot-assisted approach for the surgical treatment of prostate and renal malignancy; however, the role of robot assistance in radical cystectomy (RC) and urinary diversion for bladder cancer is less well defined. Comparison of the "iROC" trial participants to patients with bladder cancer in the United States undergoing radical cystectomy. [Extracted from the article]

The article explores the state of bladder-preserving therapies for the treatment of localized, muscle-invasive bladder cancer (MIBC). Topics discussed include the gold standard treatment for patients with nonmetastatic MIBC, the selection of patients for bladder preservation in MIBC, and the importance of the components of a therapy regimen to achieve success in organ-preserving MIBC treatment.

The article published in BJU International explores the outcomes of patients with residual cancer at radical cystectomy (RC) with or without neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer. The study, based on National Cancer Database (NCDB) data, found that NAC followed by RC was associated with improved overall survival in certain pathological stages, but worse outcomes in others. The research highlights the need for better selection criteria for NAC and the exploration of novel systemic therapies for high-risk patients with locally advanced disease. Limitations include the retrospective nature of the study and the lack of detailed information on chemotherapy regimens. [Extracted from the article]

• Significant variation exists in the management of small renal masses. • Management approach is dictated primarily by urologist preference. • Nonsurgical management increased after the AUA renal mass guideline in 2009. • Clear guidance on management is necessary to reduce unwarranted variation in care. Lack of strict indications in current guidelines have led to significant variation in management patterns of small renal masses. The impact of the urologist on the management approach for patients with small renal masses has not been explored previously. Using the linked Surveillance, Epidemiology, and End Results-Medicare database, patients aged ≥66 years diagnosed with small renal masses from January 1, 2004 to December 31, 2013 were identified and assigned to primary urologists. Mixed-effects logistic models were used to evaluate factors associated with different management approaches, estimate urologist-level probabilities of each approach, assess management variation, and determine urologist impact on choice of approach. A total of 12,402 patients with 2,794 corresponding primary urologists were included in the study. At the individual urologist level, the estimated case-adjusted probability of different approaches varied markedly: nonsurgical management (mean, 12.8%; range, 4.9%–36.1%); thermal ablation (mean, 10.8%; range, 2.4%–66.3%); partial nephrectomy (mean, 30.1%; range, 10.1%–66.6%); and radical nephrectomy (mean, 40.4%; range, 17.7%–71.6%). Compared to patient and tumor characteristics, the primary urologist was a more influential measured factor, accounting for 13.6% (vs. 12.9%), 33.8% (vs. 2.1%), 15.1% (vs. 8.4%), and 13.5% (vs. 4.0%) of the variation in management choice for nonsurgical management, thermal ablation, partial nephrectomy, and radical nephrectomy, respectively. Significant variation exists in the management of small renal masses and appears to be driven primarily by urologist preference and practice patterns. Our findings emphasize the need for unified guidance regarding management of these masses to reduce unwarranted variation in care. [ABSTRACT FROM AUTHOR]

Simple Summary: Intravesical Bacillus Calmette-Guérin (BCG) instillation is an important treatment for non-muscle invasive bladder cancer. Recent BCG shortages have forced urologists to try alternative intravesical BCG regimens to maximize a limited supply. The goal of our study was to compare the efficacy of reduced-dose induction BCG versus full-dose induction BCG in regards to bladder tumor recurrence rate. We hypothesized that patients receiving reduced-dose induction BCG would have a higher recurrence rate. In our single-center retrospective cohort of 139 patients meeting the inclusion criteria, 38.6% of patients who received reduced-dose induction BCG developed a recurrence within one year compared to 33.7% of propensity-matched patients who received full-dose induction BCG. We concluded that reduced-dose induction BCG was associated with a significantly greater risk of recurrence within one year than full-dose induction BCG therapy. These data suggested that reduced-dose induction BCG may not be equivalent or non-inferior to full-dose administration in the short term. The ongoing Bacillus Calmette-Guérin (BCG) shortage has created challenges for the treatment of non-muscle invasive bladder cancer (NMIBCa). Our objective was to evaluate the efficacy of reduced-dose induction BCG (RD-iBCG) compared to full-dose induction BCG (FD-iBCG) regarding recurrence rates. We hypothesized that patients receiving RD-iBCG may recur at a higher rate compared to those who received FD-iBCG therapy. A retrospective review of all patients with NMIBCa treated with intravesical therapy at our institution between 2015–2020 was conducted. Inclusion criteria consisted of having a diagnosis of AUA intermediate or high-risk NMIBCa with an indication for a six-week induction course of FD or RD-BCG with at least 1 year of documented follow up. The data were censored at one year. Propensity score matching for age, sex, tumor pathology, and initial vs. recurrent disease was performed. The primary endpoint was bladder cancer recurrence, reported as recurrence-free survival. A total of 254 patients were reviewed for this study. Our final cohort was 139 patients after exclusion. Thirty-nine percent of patients had HGT1 disease. 38.6% of patients receiving RD-BCG developed a recurrence of bladder cancer within a one-year follow-up as compared to 33.7% of patients receiving FD therapy. After propensity matching, this value remained statistically significant (p = 0.03). In conclusion, RD-iBCG for NMIBCa is associated with a significantly greater risk of recurrence than full-dose induction therapy, suggesting that RD-iBCG may not be equivalent or non-inferior to full-dose administration in the short term. [ABSTRACT FROM AUTHOR]

• Progressive MIBC has worse outcomes than de novo MIBC, even with neoadjuvant chemotherapy. • Progressive MIBC and de novo MIBC should be considered as distinct entities. • Consideration of additional or innovative systemic therapies should be given for progressive MIBC. To compare survival and pathologic outcomes in patients with progressive muscle-invasive bladder cancer (pgMIBC) and de novo muscle-invasive bladder cancer (dnMIBC) after radical cystectomy (RC), with a focus on the role of neoadjuvant chemotherapy (NAC). A comprehensive literature search was conducted on PubMed and EMBASE databases to identify studies comparing pgMIBC to dnMIBC. Survival outcomes, including cancer-specific survival (CSS), overall survival (OS), and recurrence-free survival (RFS), and pathologic outcomes (rates of ≤pT1, pT0, pT3/T4, and pN+ disease) were compared between pgMIBC and dnMIBC. The analysis included 19 cohorts from 16 studies, categorized into 3 groups based on NAC use: 1. patients who underwent RC and were all treated with NAC (RC + NAC only group); 2. patients who underwent RC, with or without NAC (RC +/- NAC group); 3. patients who only underwent RC without NAC (RC only group). Compared to dnMIBC, pgMIBC demonstrated worse outcomes for CSS, OS, and RFS. In the RC + NAC only group (3 cohorts), the hazard ratio (HR) for CSS was 1.52 (95% confidence interval [CI] = 1.05–2.2), while the HR for OS was 1.46 (95%CI = 1.05–2.02). Similarly, in the RC +/- NAC group (6 cohorts for CSS and 3 cohorts for OS), the HR for CSS was 1.27 (95%CI = 1.05–1.55), and the HR for OS was 1.27 (95%CI = 1.08–1.51). There were no significant differences observed in pathologic outcomes, including rates of ≤pT1, pT0, and pT3/T4 disease, across all subgroups. However, pgMIBC was associated with a higher risk of nodal metastatic (pN+) disease in the RC + NAC only group (4 cohorts, relative risk [RR] = 1.43, 95%CI = 1.12–1.84). The findings highlight the potentially worse prognosis in patients with pgMIBC compared to dnMIBC, even with the modern use of NAC. The study emphasizes the importance of careful patient counseling, further classification of patients for treatment selection, and the consideration of additional or innovative systemic therapies for pgMIBC. [ABSTRACT FROM AUTHOR]

Testicular germ cell tumors (TGCT) are one of the most common malignancies in young to middle-aged men. Though highly treatable at all stages, identifying the disease at an early stage is crucial to maximizing quality-of-life for survivors and minimizing treatment toxicity. In the United States (U.S.), access to healthcare is highly dependent on insurance status and insurance quality. Little is known about the effect of insurance providers and the TGCT disease stage in which patients are diagnosed. Herein, we attempt to investigate the relationship between the insurance provider and the TGCT disease stage. We hypothesize that patients who are uninsured or insured under Medicaid are more likely to present with higher-stage TGCT than patients who are privately insured. Using the National Cancer Database (NCDB) from 2004 to 2016, we captured all men aged 18 years or older diagnosed with TGCT. We calculated a descriptive demographic characteristic for our study cohort. Using multivariable logistic regression analysis, we identified significant predictors for the outcome of late-stage presentation. Late-stage presentation was defined as any TGCT of stage II or stage III. Further, we used a multivariable Multinomial (polytomous) logistic regression modeling to calculate the adjusted probability for TGCT stage presentation for each insurance provider. Finally, we conducted an adjusted risk difference analysis to quantify the statistical significance difference between the adjusted probability for stage presentation. We identified 70,757 individuals with TGCT;;significant predictors of presenting with;late stage TGCT;included having non-seminoma;disease compared to seminoma (OR; 3.08, 95%CI; [2.96,3.2], p <0.01), being uninsured compared to;privately insured;(OR; 1.33, 95%CI; [1.25,1.41], p <0.01), and being on Medicaid compared to private insurance (OR; 2.09, 95%CI; [1.97,2.22], p <0.01). Significant predictors are in;Table 1. Multinomial (polytomous) logistic regression modeling adjusted probability showed that Medicaid patients are less likely to present with early stage disease than;privately;insured.(Adjusted risk difference (ARD) = -0.15 [-0.16,-0.14], p <0.01), Medicaid patients are more likely to present at stage II compared to private insurance (ARD = 0.01 [0.009,0.02], p= 0.01), and Medicaid patients are more likely to present at stage III compared to privatly;insured (ARD = 0.14 [0.12,0.15], p <0.01) (figure 1). Our results support the conclusion that U.S. patients who are uninsured, publicly insured, or have unknown insurance status are significantly more likely to present with higher-stage TGCT than privately insured patients. Further, patients insured under Medicaid appear to have the greatest disparity among all these groups. In many cases, insurance status may directly result in diagnosis delay. However, the cause of this relationship is likely multifactorial and worthy of further examination. Medicaid-insured patients may have coverage for primary care. Still, they may be less likely to receive an early diagnosis due to factors not captured in NCDB, such as lower health literacy, higher rates of low English proficiency, higher rates of discrimination, and greater difficulty scheduling appointments. Reducing these disparities would result in improved quality-of-life, reduced patient costs, and lower mortality. For both individual providers and public health organizations, it is imperative to work to ensure earlier diagnosis for these patients. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic brought about a rapid expansion in telemedicine care. Now, as the public health emergency ends, healthcare professionals have pushed to permanently codify telehealth expansion to improve patient care access. Although delivery of telemedicine may exacerbate certain disparities via the "Digital Divide," it may also be an effective vehicle to deliver high-quality, accessible, and equitable oncologic care. Therefore, to determine if delivery of oncologic care via telemedicine could help reduce disparities in access and inform related policy discussions, we analyzed patient-level demographic information and self-reported clinical data of cancer patients and survivors to determine the impact of race and ethnicity on telemedicine receipt. We hypothesized that telemedicine receipt for prostate cancer patients and survivors would allow for a potential reduction in racial and ethnic differences compared to other oncological conditions. We conducted a cross-sectional analysis from July 2020 to December 2021 of telemedicine recipients who reported ever being diagnosed with cancer using the CDC's National Health Interview Survey (NHIS). Telemedicine receipt was captured using the question "In the past 12 months, have you had an appointment with a doctor, nurse, or other health professional by video or by phone?" Weighted descriptive table was calculated to estimate the national prevalence and proportions of telemedicine utilization. Further, we conducted a complex-weighted multivariable Poisson regression analysis adjusted for survey period, age, cancer type, immunocompromised status, gender, education, race and ethnicity, health status, family income, insurance coverage, and residence classification for the outcome of receipt of telemedicine. A two-way interaction between cancer type and race and ethnicity was carried out, followed by an adjusted marginal probability, and adjusted risk difference calculation to describe racial and ethnic effects for every type included in our study. Of 46,799 respondents,;6,013 (10%) reported;cancer diagnosis (a weighted population of 18.21 million). Telemedicine prevalence was 35%. Prostate cancer history significantly predicted telemedicine receipt (RR: 1.28, 95% CI: [1.16-1.42], p<0.01). Non-Hispanic Black;(NHB) people were less likely to receive telemedicine versus;Non-Hispanic White;(NHW) people (RR: 0.87, 95% CI: [0.83-0.92], p<0.01). A statistically significant interaction between race/ethnicity and cancer type (P int <0.01) prompted a marginal analysis of the adjusted probability of telemedicine receipt and the Adjusted Risk Difference (ARD) between racial/ethnic groups by cancer type. Significant differences in telemedicine receipt existed between NHB and NHW without cancer history (ARD; -0.05 [95%CI -0.07- -0.03], p<0.01) and breast cancer history (ARD: -0.16 [95%CI -0.27- -0.05], p=0.01). No statistically significant difference was found between NHB and NHW in prostate cancer (ARD: 0.05 [95%CI -0.06- -0.17], p=0.37). As the COVID-19 public health emergency winds down, policy discussions have debated the merit of codifying pandemic-level telehealth reimbursement parity into law. Our study suggests that telemedicine may help reduce disparities for prostate cancer patients, since no statistical difference was identified opposed to those with no cancer history and breast cancer. Further studies should focus on understanding best practices for telemedicine follow-up among cancer patients to ensure equitable access to care. Applying these best practices to benign diseases may prove fruitful for reducing additional disparities in access. Study limitations include its hypothesis-generating cross-sectional design and the absence of causative patient- and provider-level variables that could explain why disparities in access decrease with telehealth receipt. Despite this, we demonstrate that telemedicine receipt for patients and survivors of prostate cancer could facilitate potential reductions in overall racial disparities, suggesting that telemedicine could be a vehicle to reduce disparities among select oncologic conditions. [ABSTRACT FROM AUTHOR]

Prostate cancer (PCa) is the most prevalent non-skin cancer and the second leading cause of death from cancer in men in the United States. Evidence suggests that smoking is associated with higher-grade PCa at diagnosis with increased overall and PCa-specific mortality. Prostate specific antigen (PSA) screening significantly decreases the risk of PCa death. Previous studies indicate smokers are less likely to adhere to guideline-concordant cancer screening. Herein, we investigate the association between smoking;and PSA screening at a national level using the U.S.-based Behavioral Risk Factor Surveillance System (BRFSS) survey. We hypothesize that smokers are less likely to undergo guideline-concordant PSA screening in comparison to non-smokers. Using the 2018 BRFSS survey cycle, we analyzed men aged between 55 and 69 who responded to the cigarette smoking and PSA screening questions. Smoking status was divided into never smoker, former smoker, and current smoker. Current smoker was further divided into daily and non-daily smokers. National PSA screening prevalence was calculated for each group. A complex weighted multivariable Poisson regression modeling adjusted for age, race, marriage status, education, income, health insurance, and having a personal doctor was then used to calculate the adjusted relative risk of undergoing PSA screening. 58,996 individuals representing a national estimate of 27.04 million responded to the smoking and PSA screening questionnaires. The overall national prevalence of PSA screening was 39% [95%CI; 39%-40%]. When categorizing by smoking status, the prevalence of PSA screening for never smokers; 42% [95%CI; 41%-44%], current smokers; 27% [95%CI; 25%-29%], and former smokers 42% [95%CI; 39%-40%] (see Table 1). Among current smokers, the prevalence was 27% [95% CI; 24%-29%] for those who smoke daily and 29% [95% CI; 24%-33%] for those who do not smoke daily. The adjusted relative risk (aRR) for undergoing PSA in comparison to those who never smoked was 0.81 for current smokers (95% CI: 0.75-0.88, P < 0.01) and 0.99 for former smokers (95% CI: 0.94-1.03, P = 0.53) (Table 2). Smokers are less likely to undergo PSA screening. Delay in diagnosis is one mechanism that could explain why smokers are more likely to present with high-grade prostate cancer at diagnosis.; Interventions to increase screening in this population may improve prostate cancer outcomes.; Further quantitative and qualitative studies are needed to further understand the phenomena to aid in developing strategies to tackle the reduced PSA screening rates in smokers. [ABSTRACT FROM AUTHOR]