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Margaret F Meagher,1 Amirali Salmasi,1 Tyler F Stewart2 1Department of Urology, University of California San Diego, La Jolla, CA, USA; 2Division of Hematology-Oncology and BMT, University of California San Diego, La Jolla, CA, USACorrespondence: Tyler F Stewart, Tel +1 (866) 773-2703, Email tstewart@health.ucsd.eduAbstract: With the advent of new therapeutic modalities, management of metastatic castrate-sensitive prostate cancer (mCSPC) has been in flux. From androgen-deprivation therapy to docetaxel to androgen receptor–signaling inhibitors, each agent has heralded a new treatment paradigm. As such, the optimal first-line therapy for mCSPC remains incompletely defined. This review provides a narrative of recent advances to systemic therapy within the mCSPC treatment space, particularly with regard to expansion to triplet therapy.Keywords: metastatic, castrate-sensitive prostate cancer, darolutamide

Sohail Dhanji, Luke Wang, Franklin Liu, Margaret F Meagher, Ava Saidian, Ithaar H Derweesh Department of Urology, University of California San Diego School of Medicine, La Jolla, CA, USACorrespondence: Ithaar H Derweesh, Department of Urology, University of California San Diego School of Medicine, 3855 Health Sciences Drive, Mail Code: 0987, La Jolla, CA, 92037, USA, Tel +1 (858) 249-0900, Fax +1 (858) 822-6188, Email iderweesh@gmail.comPurpose: To review the current status of surgical and procedural treatments for renal cell carcinoma (RCC), focusing on oncological and functional outcomes, and the use of techniques for advanced disease over the last 10 years.Findings: Partial nephrectomy (PN) has become the reference standard for most T1 and T2 masses. In cT2 RCC, PN exhibits oncological equivalence and improved functional outcomes compared to radical nephrectomy (RN). Additionally, emerging data suggest that PN may be used to treat cT3a RCC. The robot-assisted platform is increasingly used to treat locally advanced RCC. Studies suggest safety and feasibility of robotic RN and robotic inferior vena cava tumor thrombectomy. Additionally, single-port robot-assisted laparoscopic approaches are comparable to multiport approaches in select patients. Long-term data show that cryoablation, radiofrequency ablation, and microwave ablation are equipotent in management of small renal masses. Emerging data suggest that microwave may effectively treat cT1b masses.Keywords: renal cell carcinoma, cryoablation, nephrectomy, microwave ablation, partial nephrectomy, radiofrequency ablation

Purpose: The aim of this project was to characterize the incidence of men's health disorders, specifically focusing on the incidence of erectile dysfunction (ED) and testosterone deficiency (TD) in a large, nationwide study of testicular cancer (TC) survivors treated in a centralized health care system., Materials and Methods: We conducted a retrospective cohort study of US veterans diagnosed with TC from 1990 to 2021. These veterans were compared with an age-matched and race-matched control group of US veterans without a diagnosis of TC. ED and TD were defined by the presence of diagnosis codes or at least a 6-month prescription for medications treating these conditions or both. Time was measured from the date of TC diagnosis (for patients with TC and matched TC patient date for the corresponding noncancer controls). Impact of chemotherapy among TC survivors on ED and TD was evaluated using multivariable Cox regression models., Results: The cohort included 1754 patients with TC compared with 7117 noncancer controls, with a mean age at diagnosis of 42 years. Patients with TC were significantly more likely than controls to experience ED (hazard ratio, 2.97; 95% CI, 2.68-3.28; P < .001) and TD (hazard ratio, 6.71; 95% CI, 5.78-7.81; P < .001). However, within the TC group, there was no significant difference in the incidence of ED and TD when stratified by receipt of chemotherapy ( P = .9 and P = .066, respectively)., Conclusions: Men's health disorders arise commonly in the lives of TC survivors. It is important for treating physicians to identify these and conduct sexual health assessments as part of survivorship care.

Introduction: Board certification in urology is a multistep process including a written qualifying examination (QE), followed by an oral certifying examination (CE) approximately 2 years after residency or fellowship completion. The goal of this process is to ensure that urologists are well trained, have an extensive fund of knowledge, demonstrate professionalism and competence in practice, and are safe to practice urology. Board certification in urology serves to both establish and confirm physician competence and ultimately protect the public. We sought to examine the relationship between board certification in urology and adverse medical license actions., Methods: We retrospectively studied deidentified physicians who attempted initial ABU certification between 1980 and 2022. The primary outcome was adverse state medical license action, defined as severe (surrendered, suspended, or denied licenses) or moderate (required CME, imposed conditions, fines, reprimands, and probations). Statistical analyses were conducted using χ 2 and Fisher exact tests., Results: Five thousand five physicians were included in analyses. One hundred nineteen physicians did not obtain board certification. Only 1.4% of physicians who certified on initial attempt received disciplinary action compared with 3.0% who obtained certification on repeated attempts (Fisher exact test 0.013, P < .05) and 5.9% who never obtained certification (Fisher exact test 0.0018, P < .05)., Conclusions: Failure to complete or repeated attempts at board certification was associated with increased rates of disciplinary actions. This association highlights the continued relevance of ABU certification in protecting the public.

Background: Despite the rise in gender-affirming care, our understanding of prostate cancer (PCa) in transgender women (TGW) remains in its infancy. Health disparities and lack of PCa awareness and screening are possible barriers to providing quality care for this population. In addition, the implication of hormonal manipulation for the aggressiveness of PCa in TGW is yet to be determined. Here, this study sought to compare oncological characteristics and survival outcomes between transgender and cisgender (CG) patients with PCa via two national data sets., Methods: The Veterans Affairs Informatics and Computing Infrastructure database (1999-2020) and the Surveillance, Epidemiology, and End Results-Medicare database (2010-2017) were reviewed. Demographic and clinical details were analyzed. Logistic regression analysis was performed on propensity score-matched groups to identify predictors of high-risk disease and metastasis in patients with PCa. Groups were matched 5:1 (CG:TGW) on the basis of age, race, year of diagnosis, and Charlson Comorbidity Index score. Primary outcomes included metastatic presentation, high-risk localized disease, overall survival (OS), and prostate cancer-specific mortality (PCSM)., Results: A total of 1194 patients were included (199 TGW; 995 CG). Associations between transgender identity and metastatic presentation (odds ratio [OR], 0.38; p = .2), high-risk localized disease (OR, 1.19; p = .50), or PCSM (hazard ratio [HR], 0.65; p = .3) were not detected. Transgender identity was associated with improved OS (HR, 0.67; p = .014)., Conclusions: PCa-specific outcomes seem comparable between TGW and CG men, although the study was underpowered to detect modest differences. Further investigation into the incidence and outcomes of PCa in TGW is warranted., (© 2024 American Cancer Society.)

We sought to evaluate the genomic and transcriptomic landscapes in primary and metastatic germ cell tumors (GCTs; N = 138) to uncover factors that drive cisplatin resistance. Prevalence was calculated for platinum-resistant alterations (PRAs; KRAS, TP53, and KIT mutations, and MDM2 amplification) and high copy number amplifications (CNA ≥ 6 copies). Tumors were designated as chemo-naïve (PreC, N = 66) or post-chemotherapy (PostC, N = 17). A transcriptomic signature associated with platinum sensitivity (PSS, high suggests increased sensitivity) was applied. KIT mutations were observed in 14.5% of primary versus 1.8% of met and 0% of lymph. TP53 mutations were identified in 10% of primary GCTs versus 17% of met and 16.7% of lymph. MDM2 CNAs were similar between sites. PRA-positive PreC GCTs had significantly lower average PSS scores compared to PRA-negative tumors. Lower PSS scores in chemo-naïve tumors were associated with PRAs, suggesting a potential mechanism for platinum resistance., (© 2024. The Author(s).)

Deer tick virus (DTV), also known as Powassan virus lineage II, is a rising health concern due to increased recognition as a cause of human encephalitis. Since European tick-borne encephalitis virus persists in nature in enzootic foci (i.e., higher prevalence rates in small pockets in nature), we sought to determine whether DTV is also focally maintained in relation to habitat type, to better understand factors leading to human risk of exposure. From 2018 to 2021, questing Ixodes scapularis ticks were collected from five habitats at the Wells National Estuarine Research Reserve (WNERR) in Wells, ME: forest with invasive vegetation in the understory, edge, shrub, forest with native vegetation in the understory, and open field. Deer tick virus prevalence was greater in adult ticks (2.0%) than in nymphs (0.5%). Deer tick virus prevalence in adult ticks collected from forest with invasive vegetation was 3.2% compared to 0 to 1.7% in other habitat types. A hot spot analysis revealed a higher number of infected adults collected per hour on one of the transects located in forest with invasive vegetation. Phylogenetic analysis of 37 full-length DTV genomes sequenced in this study revealed four major clades from the WNERR, and there was high genetic diversity within each transect, suggesting frequent, short-range dispersal between habitats. Analysis of DTV sequences from other New England counties and states also indicated long-distance dispersal to and/or from the WNERR. This study provides preliminary evidence that DTV is focal and that the risk of encountering DTV-infected ticks in forest with invasive vegetation may be greater than in other habitat types.