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IntroductionShared decision-making is widely recommended when men are considering prostate cancer screening with prostate-specific antigen (PSA). The role of patients' trust in cancer information from their physician in such decisions is unknown.MethodsWe identified male respondents ≥18 years of age from the Health Information National Trends Survey, a population-based survey of people living in the U.S. (2011-014). We assessed the association between degree of trust in cancer information from respondent's physician with patient-reported receipt of PSA-screening and patient-reported discussion of PSA screening with their physician.ResultsAmong 5069 eligible respondents, 3606 (71.1%) men reported trusting cancer information from their physician "a lot," 1186 (23.4%) "somewhat," 219 (4.3%) "a little," and 58 (1.1%) "not at all." A total of 2655 (52.4%) men reported receiving PSA screening. The degree of trust an individual had in his physician for cancer information was strongly associated with his likelihood of having received PSA screening (ptrend

Introduction: Radical cystectomy is a highly morbid procedure with 30-day perioperative complication rates approaching 50%. Our objective was to determine the effect of patients' body mass index (BMI) on perioperative outcomes following radical cystectomy for bladder cancer. Methods: We identified 3930 eligible patients who underwent radical cystectomy for nonmetastatic bladder cancer using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. The primary exposure was preoperative BMI, categorically operationalized in four strata according to the World Health Organization criteria: <18.5 kg/m², 18.5-25 kg/m², 25-30 kg/m², and >30 kg/m². Our primary outcome was major perioperative complication comprising mortality, reoperation, cardiac event, or neurological event. Results: BMI was significantly associated with rates of major complications (p=0.003): major complications were experienced by 17.0% of patients with BMI <18.5 kg/m², 7.8% of patients with BMI 18.5-25 kg/m², 7.9% of patients with BMI 25-30 kg/m², and 10.8% of patient with BMI >30 kg/m². Following multivariable adjustment for relevant demographic, comorbidity, and treatment factors, compared to patients with BMI 18.5-25 kg/m², patients with BMI <18.5 kg/m² (odds ratio [OR] 2.28; 95% confidence interval [CI] 1.07-4.78) and BMI >30 kg/m² (OR 1.59;95% CI 1.17-2.16) were significantly more likely to experience a major complication in the 30 days following cystectomy. Among the secondary outcomes, significant differences were identified in rates of pulmonary complications (p=0.003), infectious complications (p<0.001), bleeding requiring transfusion (p=0.01), and length of stay (p=0.001). Conclusions: Patients who are outside of a normal BMI range are more likely to experience major complications following radical cystectomy for bladder cancer. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Elective pelvic nodal irradiation for patients with muscle-invasive bladder cancer (MIBC) undergoing trimodal therapy (TMT) is controversial. In patients with node-negative (N0) MIBC, the benefit of elective whole-pelvis concurrent chemoradiation (WP-CCR) compared to bladder-only (BO)-CCR has not been demonstrated. Using realworld data from the National Cancer Database (NCDB), we sought to compare the overall survival (OS) between BO-CCR and WP-CCR for MIBC. METHODS: Using the 2020 NCDB Participant User File, we identified cases of MIBC diagnosed between 2017 and 2019. We selected patients with clinical T2-T4aN0M0 disease receiving CCR as first-line treatment. CCR was defined as transurethral resection of bladder tumor followed by =40 Gy radiation to the bladder with concurrent single- or multiple-agent chemotherapy. Based on elective nodal irradiation status, patients were stratified as having received BO-CCR vs. WP-CCR. OS analysis was performed using summary three-month conditional landmark, inverse probability treatment weighting (IPTW)-adjusted Kaplan-Meier estimates, and Cox regression. RESULTS: A total of 604 patients receiving CCR for MIBC were identified: 367 (60.8%) BO-CCR and 237 (39.2%) WP-CCR. Before IPTW, the groups were imbalanced in terms of baseline characteristics. The median followup of the weighted population was 42.3 months (interquartile range 18.1-49.1 months). In IPTW-adjusted Cox proportional hazards regression analysis, WP-CCR was associated with a significant OS benefit compared to BO-CCR (adjusted hazard ratio 0.72, 95% confidence interval 0.54-0.96, p=0.026). CONCLUSIONS: In the setting of CCR for N0 MIBC, this retrospective NCDB analysis revealed that WP-CCR was associated with a benefit in OS compared to BO-CCR. [ABSTRACT FROM AUTHOR]

Introduction: There are no meta-analyses of randomized controlled trials (RCTs) comparing open radical cystectomy (ORC) with robot-assisted radical cystectomy (RARC), inclusive of both intracorporeal (iRARC) and extracorporeal (hybrid RARC, hRARC) urinary reconstruction. Methods: MEDLINE, Embase, Scopus, the International Clinical Trials Registry Platform and ClinicalTrials.gov registries were searched in May 2022. Outcomes of interest included recurrence-or progression-free survival (RFS/PFS), margin status and lymph node yield, mean estimated blood loss (EBL) and operating room time (ORT), hospital length of stay (LOS), 90-day complications and readmissions, and quality of life (QoL). Pairwise meta-analyses and network meta-analyses were performed using random-effects models and Bayesian hierarchical random-effects models, respectively. Results: We found no significant differences between RARC and ORC for oncological and most perioperative outcomes: RFS/PFS (hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.67-1.23); positive surgical margins (odds ratio [OR] 1.05, 95% CI 0.60-1.85); lymph node yield (mean difference [MD] -0.63, 95% CI -2.63-1.37); LOS (MD -0.22, 95% CI -1.10-0.65); overall complications (OR 0.81, 95% CI 0.61-1.07); major complications (OR 0.94, 95% CI 0.69-1.30); readmissions (OR 0.90, 95% CI 0.60-1.35); and QoL (standardized MD -0.02, 95% CI -0.17-0.14). We found significantly lower EBL for RARC compared to ORC (MD -312.61, 95% CI - 447 to -178.22) at the expense of significantly prolonged ORT (MD 82.34 minutes, 95% CI 44.82-119.86). Network meta-analysis did not find significant differences in complications between hRARC and iRARC. Conclusions: This meta-analysis confirms the equivalence of RARC and ORC with respect to oncological outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Active surveillance (AS) is increasingly used for favorable intermediate-risk (FIR) prostate cancer (PCa). Our objective was to determine oncological and sociodemographic predictors of deferred definitive therapy and decision for radical prostatectomy (RP) vs. radiotherapy (RT). Methods: The Surveillance, Epidemiology, and End Results (SEER) Prostate with Watchful Waiting database was used to identify all FIR PCa diagnosed between 2010 and 2015 opting for AS for at least one year following diagnosis. We sought to determine predictors of treatment and treatment type using multivariable logistic regression. Results: A total of 20 334 patients were identified. An annual decrease in incident FIR patients managed initially with AS between 2010 (4061) and 2015 (2947) was noted (p for trend <0.001); 17 895 (88.0%) patients underwent deferred RP and/or RT. Patients with higher baseline cancer volume and clinical stage were significantly more likely to discontinue AS. Patients of higher socioeconomic status were more likely to undergo deferred therapy, with increased odds for RT over RP. African American patients had lower odds of undergoing definitive intervention (odds ratio 0.83, p=0.030) and were significantly more likely to opt for XRT. Oncological characteristics leading to FIR classification influenced treatment choice at the time of deferred intervention: RT was treatment of choice in 86.3% and 86.0% of Gleason group 2 and prostate-specific antigen 10-20 FIR patients, respectively; 96.1% of treated cT2b-c FIR patients opted for RP. Conclusions: Most FIR PCa patients initially managed with AS eventually undergo deferred definitive therapy, with choice of treatment significantly influenced by patients' baseline oncological and sociodemographic characteristics. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to determine the personal practices of urologists, radiation oncologists, and medical oncologists regarding prostate cancer screening and treatment using the physician surrogate method, which seeks to identify acceptable healthcare interventions by ascertaining interventions physicians select for themselves. Methods: A hierarchical, contingent survey was developed through a consensus involving urologists, medical oncologists, and radiation oncologists. It was piloted at the University of Toronto and then circulated to urologists, radiation oncologists, and medical oncologists through professional medical societies in the U.S., Canada, Central and South America, Australia, and New Zealand. The primary outcome was physicians' personal choices regarding prostatespecific antigen (PSA) screening and the secondary outcome was treatment selection among those diagnosed with prostate cancer. Results: A total of 869 respondents provided consent and completed the survey. Of these, there were 719 urologists, 89 radiation oncologists, nine medical oncologists, and 53 undisclosed specialists. Most (784 of 869 respondents; 90%) endorsed past or future screening for themselves (among male physicians) or for relatives (among female physicians). Among urologists and radiation oncologists making prostate cancer treatment decisions, there was a significant correlation between physician specialty and the treatment selected (Phi coefficient=0.61; p=0.001). Conclusions: Physicians who routinely treat prostate cancer are likely to undertake prostate cancer screening themselves or recommend it for immediate family members. Treatment choice is influenced by the well-recognized specialty bias. [ABSTRACT FROM AUTHOR]