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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. Despite the increasing availability of gender‐affirming care, our understanding of prostate cancer (PCa) in transgender women (TGW) is limited. This study comparing oncological characteristics and survival outcomes between transgender and cisgender patients with PCa suggests comparable outcomes, which indicates the need for further investigation into PCa incidence and outcomes in TGW. [ABSTRACT FROM AUTHOR]

This study evaluated the outcomes of patients with non-clear cell renal cell carcinoma (RCC) and RCC with sarcomatoid features receiving systemic treatment. We conducted a single-center retrospective analysis of 251 patients with advanced RCC receiving systemic therapy. Overall, patients with nonclear cell histology and RCC with sarcomatoid features had worse overall survival compared to those with clear cell histology. Background: Patients with nonclear cell renal cell carcinoma (RCC) and RCC with sarcomatoid differentiation have been under-represented in clinical trials. This study evaluates the outcomes and treatment patterns of patients with nonclear cell RCC and RCC with sarcomatoid features compared to those with clear cell RCC receiving systemic therapy. Methods: A single-center retrospective analysis of patients with advanced or metastatic RCC receiving systemic therapy was conducted. Patients were divided into groups based on histology: nonclear cell RCC, clear cell RCC, and RCC with and without sarcomatoid features. The primary endpoint was overall survival (OS) for each group calculated from the date of diagnosis of advanced or metastatic RCC to the date of last follow-up or death. Additionally, an exploratory analysis was conducted by nonclear cell t ype and t ype of first-line treatment. Results: Overall, 251 patients were included, with most treated before 2018. First-line therapies included vascular endothelial growth factor monotherapy (68.5%), immunotherapy monotherapy (7.6%), immunotherapy combination therapy (16.7%), or other treatments (7.2%). Overall survival was shorter for patients with nonclear cell RCC compared to clear cell RCC (39.2 months vs. 81.1 months, hazard ratio (HR), 1.60, 95% Confidence Interval 1.0, 2.6, P = .04). Additionally, OS for patients with sarcomatoid differentiation was shorter compared to patients without sarcomatoid differentiation (43.4 vs. 75.0 months, HR 1.5, 95% CI 0.8, 2.6, P = .20). Conclusion: We demonstrate inferior outcomes among patients with advanced or metastatic nonclear cell RCC and RCC with sarcomatoid differentiation receiving systemic treatment. Further prospective studies are warranted testing immunotherapy combinations and novel treatments in patients with nonclear cell RCC. [ABSTRACT FROM AUTHOR]

The role of local definitive therapy in addition to systemic treatment in clinically positive regional lymph node (cN+) bladder cancer is yet to be determined. Herein, we sought to investigate the role of radical cystectomy (RC) in management of patients with cN+ bladder cancer at US Veterans Health Administration Facilities. We identified patients diagnosed with cN+ bladder cancer between 2000-2017 using the Department of Veterans Affairs (VA) Informatics and Computing Infrastructure (VINCI). We employed a combination of database/registry coded values and chart review for data collection. To minimize mortality bias, we excluded patients who died within 90 days of diagnosis. We divided the patients into cystectomy (C) versus "no cystectomy" (NOC) cohorts. Propensity score matching was performed based on predictors of undergoing RC. Multivariable Cox models and Kaplan-Meier survival curves were used to estimate overall survival (OS) and cancer specific survival (CCS). After matching, 158 patients were included in the C and NOC groups. In the C-group, 85(54%) patients received pre-cystectomy chemotherapy, and 73(46%) patients underwent post-cystectomy chemotherapy. In the C-group, 65(41%) patients and in the NOC-group, 66(42%) patients had clinical N1 disease (P =.77). In multivariable Cox model, undergoing RC was associated with improved OS (HR0.62; 95%CI 0.47-0.81), P <.001) and CSS (HR0.58; 95%CI 0.42-0.80; P <.001). As part of multimodal treatment, undergoing RC was associated with improved OS and CSS in subset of patients with cN+ bladder cancer. Prospective randomized trials are warranted to further investigate the role of local definitive therapy in this specific patient population. The study underscores uncertainty about the efficacy of radical cystectomy (RC) alongside systemic treatment for clinically positive regional lymph node (cN+) bladder cancer. Analyzing data from cN+ patients at US Veterans Health Administration Facilities (2000–2017), the study, using propensity score matching, indicates that RC, significantly improves overall and cancer-specific survival. The findings advocate for prospective randomized trials to better understand the role of local definitive therapy in cN+ bladder cancer. [ABSTRACT FROM AUTHOR]