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INTRODUCTION: We aimed to assess the effect of a shared institutional research database on medical students’ scholarly work, perceived research competency, and self-reported satisfaction. METHODS: An institutional inventory database was created on Google Sheets with a listing of available mentors and a description of their ongoing research projects. The inventory database was shared with interested students and faculty. Students who agreed to participate were surveyed pre- and post-inventory. Survey questions assessed student demographics, prior research experience, and their perception of research competency and satisfaction. The number of presentations, publications, and articles pre- and post-inventory were also abstracted. Survey responses were compared using the Mann-Whitney U test. RESULTS: A total of 20 students were surveyed pre-inventory and at a median followup of six months (5–7) post-inventory. There was a significant increase in scholarly presentations and publications post-inventory (p<0.05 for all). Furthermore, post-inventory, students reported feeling more confident in establishing an academic career, finding good mentors, managing their relationship with their mentor, managing professional challenges, and effectively showcasing themselves professionally and describing their research (p<0.05 for all). More than 65% of students agreed or strongly agreed that the database was easy to use, accessible, transparent, and would like a similar database created for other specialty departments. CONCLUSIONS: After performing mentorship-guided research through an institutional research database, medical students felt more confident in their ability to perform research and produced more scholarly work. Therefore, we recommend a research database be created across all institutional departments to foster interest in conducting research. [ABSTRACT FROM AUTHOR]

The article discusses research on current treatments for and long-term results associated with posterior urethral valves (PUVs). It references studies by several groups, including one by C. Holmberg and colleagues in the 2011 issue of "Journal of Urology." A retrospective assessment of the patients showed a total of 24 males with PUVs since 2007. Two of the three patients who were given renal transplantation experienced reflux into the transplanted kidney.

A retrospective chart review was conducted on patients surveilled for clinical non-muscle invasive bladder cancer (NMIBC) from 2013 to 2020 to determine the impact of urine cytology on clinical decision making during NMIBC surveillance. Less than 1% of urine cytology specimens collected during NMIBC surveillance impacted clinical management, none of whom had low-risk disease. The use of urine cytology for surveillance of low-risk NMIBC should continue to be strongly discouraged, as it did not change management in any such cases. Introduction: The use of urine cytology in the surveillance of non-muscle invasive bladder cancer (NMIBC) is widely variable in clinical practice. We studied the impact of surveillance urine cytology on clinical decision making during NMIBC surveillance. Methods: A retrospective chart review was conducted on patients surveilled for clinical NMIBC from 2013 to 2020 with at least one follow-up cytology result after diagnosis. Patients were classified into risk categories according to American Urological Association (AUA) NMIBC guidelines. Data were obtained regarding tumor recurrence pathology and the frequency and findings of surveillance cystoscopies and urine cytologies. Positive (suspicious, malignant) and negative (atypical or negative for malignant cells) cytology results were correlated with cystoscopy and pathology findings when obtained within 3 months of the cytology specimen to determine if cytology impacted plan of care. Results: Two hundred fourteen patients with NMIBC were followed for a median of 34 months, with 1045 urine cytologies collectively obtained over the surveillance period. There were no positive urine cytologies among patients with low-risk NMIBC; therefore, cytology did not change management in this cohort. The potential for cytology to escalate management for patients of any risk group (ie, positive cytology in the absence of positive cystoscopy or pathology findings) occurred in 30 (2.9%) cases. However, clinical decision making was only altered in 4 cases (0.4% of all cytologies). Conclusions: Less than 1% of urine cytology specimens collected during NMIBC surveillance impacted clinical management, none of whom had low-risk disease. The use of urine cytology for surveillance of low-risk NMIBC should continue to be strongly discouraged, as it did not change management in any such cases. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this review is to highlight the unique factors that predispose geriatric patients to nephrolithiasis and to compare the utility and efficacy of surgical techniques in this specific patient population. Methods: PubMed and EMBASE databases were reviewed, and studies were organized according to surgical treatments. Results: Few prospective studies exist comparing kidney stone removal in the elderly to younger cohorts. In addition, various age cut-offs were used to determine who was considered elderly. Most studies which analyzed Percutaneous Nephrolithotomy (PCNL) found a slightly higher rate of minor complications but comparable stone free rate and operative time. For ureteroscopy (URS) and extracorporeal shockwave lithotripsy (ESWL), there were minimal complications observed and no difference in clinical success in the elderly. All surgical techniques were presumed to be safe in the elderly and most found no difference in stone-free rates. Conclusions: Unique attributes of the geriatric population contribute to stone formation and must be considered when determining appropriate management modalities. This review provides an overview of the utility and efficacy of PCNL, URS and ESWL in the elderly, as well as a porposed algorithm for management in this population. [ABSTRACT FROM AUTHOR]

To design and implement a simple electronic medical record-based ureteral stent tracker. To assess its impact on stent dwell time and stent-related complications. Patients with stents placed 12 months before and 6 months after stent tracker implementation were identified at 3 urban hospitals. Those with stents-on-strings and intentional chronic indwelling stents (greater than 90 days) were excluded. Patient demographics, stent characteristics (eg, indication, string, dwell time), and clinical outcomes (eg, positive urine cultures, complications) were reviewed and compared between pre- and posttracker cohorts. A 12-question usability survey was administered to surgical nurses to assess usability. A total of 323 stents (173 pre- and 150 posttracker) were placed in 217 patients. The prestent tracker cohort had a longer mean dwell time (pre: 40.9 ± 59.1 days vs post: 28.8 ± 22.0 days, P =.02) and a higher retention rate >90 days (pre: 8.1% [14/173] vs post: 1.3% [2/150], P =.005). The 2 cohorts had no significant differences in positive urine culture rates, patient phone calls to providers, stent-related emergency department visits, or hospitalizations. The usability survey showed that 86.4% of surgical nurses found the tracker to be user-friendly and 95.5% reported that it added less than 1 minute of work per procedure. Implementation of an electronic medical record-based ureteral stent tracker decreased average stent dwell time and frequency of retained stents. Surgical nurses reported the tracker to be user-friendly and convenient. Stent trackers can improve the efficiency of postoperative removal of indwelling ureteral stents. [ABSTRACT FROM AUTHOR]

To evaluate patient understanding of risks, benefits, and alternatives (R/B/A) prior to urological procedures using the teachback method. Using a preprocedural phone interview, patients recalled general knowledge and R/B/A of a scheduled procedure. A scoring system compared patient responses to a standardized R/B/A list to analyze the level of understanding, graded as incomplete (<25%), partial (25-75%), or complete (>75%). Following the interview, additional education was provided if understanding was inadequate, and patients were queried regarding their satisfaction. Patients (n = 99) comprised 46% women; 32% Spanish speaking; Mean age was 64 ± 10.9 years. Procedures included were: intravesical botulinum toxin injection (24), mid-urethral sling (9), colpocleisis (4), prostate biopsy (24), ureteroscopy (16), transurethral resection prostate (11), transurethral resection bladder tumor (11). Across all procedures, the average percent of risks identified was 12%, benefits 63%, and alternatives 35%. No patients had complete understanding, but most had partial (73.7%). Patients had significantly higher level of understanding if they were female (P = 0.02), underwent the same procedure previously (P < 0.01) or any surgery within a year (P = 0.02), and were undergoing an in-office procedures (P = 0.03). After the teachback interview, most patients (90%) were satisfied with their understanding. In our cohort, patient understanding was alarmingly incomplete and there was substantial benefit in pre-procedural interviews. Our findings highlight the need for improvement in patient education prior to surgery and offers a potential solution using a teachback-based telephone interview. [ABSTRACT FROM AUTHOR]

Introduction: Opioids are often used to manage postoperative pain. Non-narcotic alternatives have increasingly been used to reduce opioid usage. We conducted an open-label randomized non-inferiority clinical trial to compare non-opioid to opioid therapy for pain management after nephrolithiasis surgery. Methods: Patients undergoing elective ureteroscopy or percutaneous nephrolithotomy between July 2018 and May 2021 were randomized to receive ketorolac (non-opioid) or oxycodone-acetaminophen (opioid). Each patient was surveyed one week postoperatively to assess pain outcomes. Patient demographics, surgical variables, number of pills used, constipation, and adverse events were also assessed. We evaluated whether non-opioid analgesia was non-inferior to opioid analgesia for postoperative pain, assuming a non-inferiority margin of 1.3 in pain score between groups. Results: Analyses were based on 90 patients with postoperative pain data: 44 in the ketorolac group and 46 in the oxycodone-acetaminophen group. The groups were similar regarding demographics, type of surgery, ureteral stent placement, and stone burden. Non-inferiority of non-opioids compared to opioids was demonstrated for all outcomes. At follow-up, the average pain scores were 3.20 ± 1.94 (SD) in the non-opioid group and 4.17 ± 1.84 in the opioid group (difference = − 0.96; 95% CI: − 1.76, − 0.17, p = 0.018). The mean proportions of unused pills were similar between groups (p = 0.47) as were rates of constipation (p = 0.32). Conclusions: Non-opioid analgesia was non-inferior to opioid analgesia in pain management after kidney stone surgery. This trial contributes to the evidence that non-opioid analgesics should be considered an effective option for pain management following non-invasive urologic procedures. [ABSTRACT FROM AUTHOR]

Objective: To study implicit and explicit gender biases in YouTube videos describing common urologic conditions based on language patterns, speaker gender, and speaker profession.Methods: Using a Boolean search, the top 30 videos for benign prostatic hyperplasia (BPH), kidney stones, urinary tract infections (UTIs), overactive bladder (OAB), erectile dysfunction (ED), and pelvic organ prolapse (POP) were retrieved. Using the Linguistic Inquiry and Word Count program (LIWC) software, video transcripts were analyzed for 16 word categories and compared by speaker gender and urology topic to assess for bias.Results: OAB and POP had the least view counts and subscribers; kidney stone and ED videos had the most. Student education channels were more likely to feature male than female speakers (19 male vs. 6 female, P=0.01). A significant difference was noted between speaker gender in BPH (25 male vs. 4 female, P<0.001), OAB (4 male vs. 22 female, P<0.001), and POP (6 male vs. 23 female, P<0.001) videos. When examining linguistic patterns with the LIWC program, female speakers were more likely to mention personal concerns and use tentative words when speaking alone compared to males.Conclusions: Gender bias exists in YouTube videos concerning common urologic conditions. We must be mindful of how information is distributed in order to minimize the perpetuation of gender stereotypes that are common in medicine. Awareness of these patterns and biases should encourage Urologists to proactively consider how they present themselves and how they reference the conditions they present in social media outlets. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the relationship between self-reported food security and kidney stone formation. Methods: Data were collected from the National Health and Nutrition Examination Survey (NHANES), a database representative of the United States population. Food security status was assessed using the US Household Food Security Survey Module: Six-Item Short Form. Characteristics of patients were compared using the Chi-square test and the student t-test. Multivariate logistic regression was performed using a multi-model approach. Results: We analyzed 6,800 NHANES survey respondents. 37.2% of respondents were categorized as having "low food security" (scores 2–4) and 24.0% having "very low food security" (scores 5–6). 8.4% of respondents had a history of kidney stones. We found that people with very low food security had a 42% increased likelihood of developing kidney stones compared to those with high or marginal food security, after controlling for race, age, and comorbidities (OR 1.42; 95% CI 1.01–1.99). Between the different food security groups, no significant differences were observed in age, race/ethnicity, body mass index, gout history, osteoporosis history, or coronary artery disease history. Lower food security was associated with slightly younger age (< 1 year difference, p = 0.001), higher poverty-income ratio (p = 0.001), and many comorbidities, including kidney stones (p = 0.007). Conclusion: Our study provides evidence for an association between food access and the risk of kidney stone disease. Given these findings, food insecurity should be investigated as a modifiable risk factor for the development of kidney stone disease. [ABSTRACT FROM AUTHOR]

Objective: To analyze Twitter engagement in response to the urology match during the COVID-19 pandemic.Methods: Tweets containing the hashtags "#uromatch" or "#AUAmatch" during the 2021 and 2022 Match Week were reviewed. Date, author type and number of followers, general content, and engagement with each Tweet was collected. Differences in engagement between author type and content were analyzed using the Kruskal-Wallis H test. Tweet characteristics were compared between the 2021 and 2022 Match Cycles using the Chi-Square test.Results: There were 656 Tweets in total, with 272 (43.5%) from 2021 and 353 (56.5%) from 2022. Medical students' and residency programs' posts received significantly more Tweet engagement than those by residents/fellows, attendings, or the AUA (P <.05). Tweets focusing on announcing a new residency class and personal announcements of match results received significantly more engagements than other content categories (P <.05). In 2022, there was a significantly higher percentage of Tweets about advice for unmatched applicants (2.2 vs 12.5; P <.001), match statistics (0.4 vs 2.9; P = .028) and focus on underrepresented groups in urology (0.7 vs 3.4; P = .029).Conclusion: The Twitter response to the urology match between 2021 and 2022 mirrored the increase in competitiveness, with greater participation and an increasing focus on the difficulty of matching. During Match Week, Twitter is a readily available source of information for programs, matched students, and unmatched students alike. As we continue to embrace virtual platforms, we believe that Twitter will remain a major source of match-related information and can be an instrumental tool for broader networking in our field. [ABSTRACT FROM AUTHOR]

Objective: To perform a systematic review of mixed epithelial stromal tumor of the seminal vesicle (SV) to characterize the diagnosis and treatment of this rare condition.Methods: "Seminal vesicle mixed epithelial stromal tumor" OR "seminal vesicle cystadenoma" were searched on PubMed/MEDLINE for relevant articles through 6 September 2021. Articles were eligible if they were in English, accessible via our university library services, and if the abstract was concordant with the content of the publication. Reference lists of included articles were reviewed to identify additional relevant articles.Results: In total, 66 articles were identified, of which 34 (N = 36 patients) were included. The most common presenting symptoms were lower urinary tract symptoms (33%, 12/36), dysuria (22%, 8/36), lower abdominal pain (17%, 6/36), and hematuria (17%, 6/36). However, there were eight cases (23%, 8/36) of asymptomatic incidental SV tumors. A biopsy was performed in 47% of cases (17/36), of which 53% (9/17) showed benign findings, 29% (5/17) were inconclusive, and 18% (3/17) SV cystadenoma. Surgical resection was performed using open (57%, 20/35), laparoscopic (26%, 9/35), or robotic (17%, 6/35) techniques. The majority (94%, 34/36) of the SV tumors were low-grade. Long-term follow-up was reported for 15 patients in which two patients (13%, 2/15) had tumor recurrence.Conclusion: High rate of inconclusive biopsy of SV tumors suggests that routine biopsy is of questionable utility. Surgical excision frequently relieves symptoms and confirms accurate pathologic diagnosis. After tumor removal, patients should be surveilled with cross-sectional imaging of the pelvis given the possibility of tumor recurrence. [ABSTRACT FROM AUTHOR]

Objective: To perform a systematic review and a retrospective cohort analysis evaluating the rates of surgical downgrading of prostate cancer (PCa) from biopsy (PBx) to radical prostatectomy (RP), and their association with biochemical recurrence (BCR) in a multiethnic population. Methods: A systematic review of PubMed and other databases was performed. We included retrospective studies evaluating the relationship between surgical downgrading and BCR-free survival. Data regarding Gleason score (GL) downgrading were abstracted from the articles and categorized as follows: GL8-10 to GL7, GL7 to GL6, and GL 7(4 + 3) to GL7(3 + 4). We also performed a retrospective cohort review of patients who underwent RP at our institution from 2005 through 2020. Kaplan–Meier survival analysis and Cox proportional hazards models were used to compare BCR among downgraded versus non-downgraded men. Results: Systematic review yielded 137 abstracts; of these, 36 full-texts were reviewed, 8 of which were included in our systematic review. Despite substantial variability, all showed that GL at RP is one of the most important factors of BCR-free survival. A total of 1,484 men with PCa were analyzed from our institution. On multivariate analysis, GL7 to GL6 downgrading (HR = 0.50, p = 0.022) and GL8-10 to GL7 downgrading (HR = 0.42, p = 0.011) were associated with reduced risk of BCR when compared to men with GL7 and GL8-10 concordance, respectively. However, GL7(4 + 3) to GL7(3 + 4) downgrading was not significantly associated with reduced BCR (HR = 0.56, p = 0.12), when compared to GL7(4 + 3) concordance, although HR was similar. Conclusion: Surgical downgrading at RP was associated with a reduced risk of BCR compared to GL concordant disease, and these findings have been validated within our multiethnic population. Pathologic downgrading at the time of RP may be a more useful predictor of subsequent BCR in comparison to that associated with GL concordant pathology. [ABSTRACT FROM AUTHOR]

• CFB and IGFB offer similar detection rates of cs-CaP in a multiethnic population. • For cs-CaP, CFB and IGFB had similar rates of concordance to systematic biopsy. • For overall CaP, CFB had higher rates of discordance than IGFB. Transrectal ultrasound-guided prostate biopsy remains the most used method for the detection of prostate cancer. We recently reported that detection of clinically significant prostate cancer (cs-CaP) using image-guided fusion biopsies (IGFB) varied by race/ethnicity, which calls for further comparison between cognitive fusion biopsy (CFB) and IGFB among non-Hispanic black and Hispanic populations. Therefore, the aim of our study is to compare the rates of detection of cs-CaP and overall CaP by CFB and IGFB in a multiethnic community. We performed a retrospective, cross-sectional review of men who underwent MRI-transrectal ultrasound-guided prostate biopsy at our diverse, urban academic medical center. Agreement and discordance between fusion biopsies and systematic biopsies for detection of cs-CaP and overall CaP were determined using Kappa statistics. Univariate and multivariate mixed-effects logistic regression models were used to find associations between fusion modalities and prostate cancer detection. In total, 710 men underwent fusion prostate biopsies between December 2015 and June 2021. Upon univariate and multivariate logistic regression analysis, there was no significant association between IGFB vs. CFB and risk of overall CaP (OR = 0.66, 95% CI: 0.36–1.21, P = 0.18) or cs-CaP (OR = 0.57, 95% CI: 0.30–1.08, P = 0.09). We found moderate agreement between fusion and systematic biopsies for both CFB (κ = 0.56) and IGFB (κ = 0.52) in cs-CaP. CFB and IGFB offer similar detection rates of cs-CaP in a multiethnic population. CFB represents an effective and accessible means of accurately diagnosing prostate cancer. [ABSTRACT FROM AUTHOR]

The prostate is a hormone-responsive organ where testicular androgens drive the proliferation and survival of prostatic cells, ensuring the development and functioning of this gland throughout life. Androgen deprivation therapy leads to apoptosis of prostatic cells and organ regression, and is a cornerstone of prostate cancer and benign prostatic hypertrophy treatment. For several decades, androgen deprivation has been used as an adjuvant to external beam radiotherapy, however, emerging data suggests that the low rates of epithelial proliferation in the castrated prostate imparts radio-resistance. As proliferating cells exhibit increased sensitivity to radiation, we hypothesized that short bursts of synchronized epithelial proliferation, which can be achieved by exogeneous testosterone supplementation prior to targeted high-dose radiation, would maximize sustained prostate ablation, while minimizing damage to surrounding tissues. To test this hypothesis, we designed a novel computed-tomography (CT)-guided stereotactic prostate radiation therapy (CT-SPRT) technique to deliver a single high-dose 25 Gy fraction of X-ray radiation. Sustained prostatic cell ablation was assessed post CT-SPRT by measuring prostate weight, epithelial cell number, and relative contributions of luminal and basal epithelial populations in control and testosterone-pretreated glands. CT-SPRT was safely delivered with no observed damage to surrounding rectal and bladder tissues. Importantly, castrated mice that received a pulse of testosterone to induce synchronous cell proliferation prior to CT-SPRT exhibited significant sustained gland ablation compared to control mice. These results provide new insights in stereotactic radiotherapy sensitivity to maximize prostatic cell ablation and improve our understanding of prostate gland regeneration that can potentially lead to improved non-invasive therapies for benign prostatic hypertrophy and prostate cancer. [ABSTRACT FROM AUTHOR]

Duplication of the vas deferens is a rare congenital anomaly that has been encountered during inguinal hernia repair, orchidopexy, varicocelectomy, vasectomy, and radical prostatectomy. Identification of the duplicated vas deferens is crucial intraoperatively to avoid iatrogenic injury to the structure and the risks that come with failure to correctly distinguish the structure. We report a case of duplicated vas deferens and incarcerated urinary bladder during a laparoscopic converted to open left direct inguinal hernia repair., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Jindani et al.)

Purpose: Asian, Black, and Hispanic men are underrepresented in prostate cancer (PCa) clinical trials. Few novel prostate cancer biomarkers have been validated in diverse cohorts. We aimed to determine if Stockholm3 can improve prostate cancer detection in a diverse cohort., Methods: An observational prospective multicentered (17 sites) clinical trial (2019-2023), supplemented by prospectively recruited participants (2008-2020) in a urology clinic setting included men with suspicion of PCa and underwent prostate biopsy. Before biopsy, sample was collected for measurement of the Stockholm3 risk score. Parameters include prostate-specific antigen (PSA), free PSA, KLK2, GDF15, PSP94, germline risk (single-nucleotide polymorphisms), age, family history, and previous negative biopsy. The primary endpoint was detection of International Society of Urological Pathology (ISUP) Grade ≥2 cancer (clinically significant PCa, csPC). The two primary aims were to (1) demonstrate noninferior sensitivity (0.8 lower bound 95% CI noninferiority margin) in detecting csPC using Stockholm3 compared with PSA (relative sensitivity) and (2) demonstrate superior specificity by reducing biopsies with benign results or low-grade cancers (relative specificity)., Results: A total of 2,129 biopsied participants were included: Asian (16%, 350), Black or African American (Black; 24%, 505), Hispanic or Latino and White (Hispanic; 14%, 305), and non-Hispanic or non-Latino and White (White; 46%, 969). Overall, Stockholm3 showed noninferior sensitivity compared with PSA ≥4 ng/mL (relative sensitivity: 0.95 [95% CI, 0.92 to 0.99]) and nearly three times higher specificity (relative specificity: 2.91 [95% CI, 2.63 to 3.22]). Results were consistent across racial and ethnic subgroups: noninferior sensitivity (0.91-0.98) and superior specificity (2.51-4.70). Compared with PSA, Stockholm3 could reduce benign and ISUP 1 biopsies by 45% overall and between 42% and 52% across racial and ethnic subgroups., Conclusion: In a substantially diverse population, Stockholm3 significantly reduces unnecessary prostate biopsies while maintaining a similar sensitivity to PSA in detecting csPC.

Introduction: Social determinants of health (SDH) are nonbiologic influencers of disease and health care disparities. This study focused on understanding the association between SDH and urology clinic "no-show" visits within a diverse urban population., Methods: We retrospectively identified patients scheduled for urology clinic visits from October 2015 to June 2022 who completed a 10-question social needs screener. For each patient, demographic variables, and number of missed clinic appointments were abstracted. Multivariable logistic regression was performed to determine the association of unmet social needs and no-shows., Results: Of 5761 unique patients seen in clinic, 5293 completed a social needs screener. Respondents were most commonly male (62.8%), Hispanic (50.3%), English-speaking (75.5%), and insured by Medicare (46.0%). Overall, 8.2%, 4.6%, and 6.1% reported 1, 2, and 3+ unmet social needs, respectively. Most patients (61.7%) had 0 no-shows; 38.3% had 1+ no-shows. Between the 0 and 1+ no-show groups, we found significant differences with respect to gender ( P =.05), race/ethnicity ( P = .002), preferred language ( P = .006), insurance payer ( P < .001), SDH status ( P = .003), and total number of unmet social needs ( P = .006). On multivariable analysis, patients concerned about housing quality (odds ratio [OR] = 1.50, P = .002), legal help (OR = 1.53, P = .009), and with 3+ unmet social needs (OR = 1.39, P = .006) were more likely to have 1+ no-shows., Conclusions: Unmet social needs were associated with increased no-show urology clinic visits. Routine social needs screening could identify at-risk patients who would benefit from services. This may be particularly pertinent for patients with urgent diagnoses or those requiring frequent office visits where missing appointments could impact morbidity and mortality.

Purpose: There is not yet satisfactory performance data comparing multiparametric MRI (mpMRI) versus biparametric MRI (bpMRI) for detecting prostate cancer (PCa), particularly in high-risk populations. We compared both protocols for detecting overall PCa and clinically significant PCa (CS-PCa; defined as Grade Group ≥ 2) in a multiethnic urban population., Methods: We retrospectively reviewed electronic medical record data from men who underwent image-guided fusion prostate biopsy (FB) between 2016 and 2021 at our institution. Patient characteristics, Prostate Imaging Reporting and Data System (PI-RADS) scores, and FB outcomes were analyzed based on MRI protocol. Multivariate mixed-effects logistic regression models were used to examine associations of bpMRI versus mpMRI for detecting overall PCa and CS-PCa in targeted lesions, among all patients and stratified by race/ethnicity., Results: Overall, 566 men (44.0% Non-Hispanic Black [NHB]; 27.0% Hispanic) with 975 PI-RADS 3-5 lesions on MRI underwent FB. Of these, 312 (55%) men with 497 lesions underwent mpMRI and 254 (45%) men with 478 lesions underwent bpMRI. On multivariate analyses among all men, the odds of detecting overall PCa (OR = 1.18, 95% CI: 1.05-3.11, p = 0.031) and CS-PCa (OR = 2.15, 95% CI: 1.16-4.00, p = 0.014) on FB were higher for lesions identified on bpMRI than mpMRI. When stratified by race/ethnicity, the odds of detecting overall PCa (OR = 1.86; p = 0.15) and CS-PCa (OR = 2.20; p = 0.06) were not statistically different between lesions detected on bpMRI or mpMRI., Conclusion: BpMRI has similar diagnostic performance to mpMRI in detecting overall and CS-PCa within a racially/ethnically diverse population. BpMRI can be utilized for evaluating suspected CS-PCa among NHB and Hispanic men., (© 2024. The Author(s).)

Background: The role of prostate-specific antigen (PSA) testing in prostate cancer (PCa) screening has evolved over recent decades with multiple randomized controlled trials (RCTs) spurring guideline changes. At present, controversy exists due to the indolent nature of many prostate cancers and associated risks of overdiagnosis and overtreatment. This review examines major RCTs evaluating PSA screening to inform clinical practices., Methods and Materials: We summarize findings from primary RCTs investigating PSA screening's impact on PCa mortality and incidence: the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, the European Randomized Study of Screening for Prostate Cancer (ERSPC), and the Cluster Randomized Trial of PSA Testing for Prostate Cancer (CAP)., Results: The PLCO Trial randomized men to annual PSA and DRE screening or usual care, reporting no significant difference in PCa mortality between groups at 17 years (RR 0.93, [95% CI: 0.81-1.08]), yet significantly increased detection and concomitant decreased detection in Gleason 6 (RR 1.17, [95% CI: 1.11-1.23]) and 8-10 disease (RR 0.89, [95% CI: 0.80-0.99]) in the screening group, respectively. The ESPRC Trial randomized men across seven European countries to PSA screening every 2-4 years or usual care, noting a 20% reduction in PCa mortality at 9 years (RR 0.81, [95% CI: 0.65-0.98]) and significant decrease in metastatic disease at 12 years (RR 0.70, [95% CI: 0.60-0.82]). The CAP Trial assessed a single PSA screening test's impact on PCa mortality yielding no significant difference in PCa mortality at 10 years (RR 0.96, [95% CI: 0.85-1.08]). Limitations amongst studies included high contamination between study arms and low compliance with study protocols., Conclusions: While the CAP and initial PLCO trials showed no significant reduction in PCa mortality, the ERSPC demonstrated a 21% reduction at 13 years, with further benefits at extended follow-up. Differences in outcomes are attributed to variations in trial design, contamination, adherence rates, and PSA thresholds. Future studies are needed focus on optimizing screening intervals, targeting high-risk populations, and incorporating non-invasive diagnostic tools to improve screening efficacy and reduce associated harms., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)