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Dendritic cells (DCs) regulate immunity and inflammation and respond to various stimuli, including cytokines. IL-1β is a key cytokine in the course of both acute and chronic inflammatory responses, making it indispensable for protection of the host, but also linking it to several diseases. Thus, IL-1β signaling must be tightly regulated. As suppressor of cytokine signaling (SOCS) proteins effectively control immune responses, we investigated the role of SOCS2 in IL-1β-induced DC activation. Human monocyte-derived DCs were stimulated with IL-1β, and SOCS2 mRNA and protein levels were measured. DC activation was assessed by cytokine secretion and surface marker expression. For functional analysis, small interfering RNA (siRNA)-based SOCS2 silencing was performed. SOCS2 expression was also analyzed in a curated NCBI GEO dataset of myeloid leukemia patients. We found IL-1β to be a potent inducer of SOCS2 expression. By silencing SOCS2, we showed that SOCS2 specifically limits IL-1β-induced IL-8 secretion. Moreover, our analysis revealed that SOCS2 levels are significantly increased in patients with acute and chronic myeloid leukemia, two hematological malignancies where disease progression is closely linked to IL-1β. This study identifies SOCS2 as a novel IL-1β-inducible target gene and points toward a potential role of SOCS2 in IL-1β-mediated DC activation.

Objective: To investigate changes in whole body pain during urologic chronic pelvic pain syndrome (UCPPS) flares., Materials and Methods: UCPPS participants at one site of the multidisciplinary approach to the study of chronic pelvic pain research network reported their daily flare status and pain levels in 7 pelvic/genital and 42 extrapelvic body areas (scale = 0-10) for 10 days at baseline and during their first flare. Linear mixed models and conditional logistic regression were used to investigate symptom changes during flares. Analyses were stratified by chronic overlapping pain condition (COPC) status., Results: Fifty-five out of 60 participants completed the study, 27 of whom provided information on both nonflare (n = 281) and flare (n = 208) days. Pelvic/genital pain intensity (mean change = 3.20 of 10) and widespreadness (mean = 1.48) increased significantly during flares for all participants (all P interaction > .1), whereas extrapelvic pain intensity increased significantly only among participants with COPCs (mean = 2.09; P interaction < .0001). Pelvic/genital and extrapelvic pain also varied on nonflare days but symptom fluctuations were generally ≤1 point (80.0%-100% of participants). Increases of ≥2 points in pelvic/genital pain intensity (odds ratio (OR) = 22.0, 95% confidence interval (CI) = 4.0-118.6) and ≥1 point in urination-related pain (OR = 9.10, 95% CI = 1.74-47.7) were independently associated with flare onset for all participants., Conclusion: Our observations of extrapelvic pain increases during flares for patients with COPCs and our independent associations between pelvic/genital/urination-related pain intensity and flare onset may provide insight into mechanisms underlying flare development (eg, common biologic pathways between UCPPS phenotypes and flares), flare management (eg, local vs systemic therapies by COPC status), and patient flare definitions., (© 2019 Wiley Periodicals, Inc.)

Background: Kidney transplantation is the optimal treatment in end stage renal disease but the allograft survival is still hampered by immune reactions against the allograft. This process is driven by the recognition of allogenic antigens presented to T-cells and their unique T-cell receptor (TCR) via the major histocompatibility complex (MHC), which triggers a complex immune response potentially leading to graft injury. Although the immune system and kidney transplantation have been studied extensively, the subtlety of alloreactive immune responses has impeded sensitive detection at an early stage. Next generation sequencing of the TCR enables us to monitor alloreactive T-cell populations and might thus allow the detection of early rejection events., Methods/design: This is a prospective cohort study designed to sequentially evaluate the alloreactive T cell repertoire after kidney transplantation. The TCR repertoire of patients who developed biopsy confirmed acute T cell mediated rejection (TCMR) will be compared to patients without rejection. To track the alloreactive subsets we will perform a mixed lymphocyte reaction between kidney donor and recipient before transplantation and define the alloreactive TCR repertoire by next generation sequencing of the complementary determining region 3 (CDR3) of the T cell receptor beta chain. After initial clonotype assembly from sequencing reads, TCR repertoire diversity and clonal expansion of T cells of kidney transplant recipients in periphery and kidney biopsy will be analyzed for changes after transplantation, during, prior or after a rejection. The goal of this study is to describe changes of overall T cell repertoire diversity, clonality in kidney transplant recipients, define and track alloreactive T cells in the posttransplant course and decipher patterns of expanded alloreactive T cells in acute cellular rejection to find an alternative monitoring to invasive and delayed diagnostic procedures., Discussion: Changes of the T cell repertoire and tracking of alloreactive T cell clones after combined bone marrow and kidney transplant has proven to be of potential use to monitor the donor directed alloresponse. The dynamics of the donor specific T cells in regular kidney transplant recipients in rejection still rests elusive and can give further insights in human alloresponse., Trial Registration: Clinicaltrials.gov: NCT03422224 , registered February 5th 2018.

Purpose: We performed clustering analysis of patient symptoms to discover common patient subtypes in females and males with interstitial cystitis/bladder pain syndrome or chronic prostatitis/chronic pelvic pain syndrome., Materials and Methods: The clinical variables included in k-means clustering were urological pain severity, urinary urgency, frequency and nonurological pain, each on a 0 to 10 numerical rating scale, and a yes or no response to each of the 6 UPOINT (Urological Treatment Program for Chronic Prostatitis) domains, including the urinary, psychosocial, organ specific, infection, neurological/systemic and skeletal muscle tenderness domains., Results: Included in study were 211 patients seeking care of interstitial cystitis/bladder pain syndrome or chronic prostatitis/chronic pelvic pain syndrome. The k-means clustering algorithm identified 3 clusters of patients with interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome, including 1) a mild pelvic symptom cluster in about 30% of patients, 2) a severe pelvic symptom cluster in about 40% and 3) a systemic symptom cluster in about 30%. Patients in the systemic cluster were younger by about 5 to 7 years and more likely to be female. They had the most severe urinary symptoms (urgency, frequency and painful bladder filling), and the most severe pelvic and nonpelvic pain. They were also more likely to have chronic overlapping pain conditions, psychosocial issues (depression, anxiety and somatic symptoms) and poorer quality of life than patients in the 2 other pelvic clusters. They were not less likely to have Hunner lesions in the bladder., Conclusions: Symptom based clustering identified 3 clusters of patients with interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome. These patient subtypes had different pelvic and systemic presentations. Patients in the systemic cluster may benefit from interdisciplinary therapies. Future studies are needed to elucidate differences in pathophysiology among these clusters.

Effect-directed isolation of free radical scavengers from the methanol extract of the freeze-dried fruiting bodies of the cultivated basidiomycetous mushroom, black poplar (Cyclocybe cylindracea), yielded a β-carboline alkaloid. Its structure was determined based on ESI-TOF-MS/MS, NMR and circular dichroism spectra by comparison with published data. The compound, identified as the C1-S diastereomer of brunnein B, exhibited explicit radical scavenging activity (EC 50  = 119.1 ± 1.2 μg/mL). The quantity of the active component was determined with HPLC-MS in the fruiting body (36.2 ± 2.8 ng/g DW, dry weight) and its different tissues such as peel (94.7 ± 1.9 ng/g DW), inner cap (90.5 ± 1.3 ng/g DW), gills (71.5 ± 0.6 ng/g DW), and stipe (162.2 ± 1.7 ng/g DW). It is a β-carboline alkaloid that was not reported previously., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objectives: (1) To compare the severity and distribution of nonurologic and urogenital pain between overactive bladder (OAB), interstitial cystitis/bladder pain syndrome (IC/BPS) and controls, and (2) To examine the relationships between the severity of urogenital pain and severity of urinary symptoms among patients with OAB., Subjects and Methods: Fifty-one OAB patients, 27 IC/BPS patients, and 30 controls were recruited. Nonurologic pain was assessed using a whole body map and Brief Pain Inventory. Urologic pain was assessed using the Interstitial Cystitis Symptom and Problem indexes, Genitourinary Pain Index, and 0-10 pain scale. Urogenital pain was assessed using a genital map, and report of pain related to bladder filling and urination., Results: Among OAB patients, 6% reported pelvic pain only while 28% reported pelvic pain and beyond. 18% reported widespread pain. The distribution of nonurologic pain and urogenital pain in OAB patients were intermediate between IC/BPS and controls (IC/BPS>OAB>controls, P all <.05). The intensity of pain reported by OAB patients was intermediate between controls and IC/BPS (average 2.3 vs 0.8 vs 4.3 out of 10, P <.001). Among OAB patients, the pain severity (GUPI-pain, ICSI-pain, ICPI-pain) was positively correlated with urinary severity (UDI-6, IIQ-7, OABq-SS, OABq-QOL, P all < .05). OAB patients with pelvic pain have worse urinary symptoms and psychosocial health (anxiety, depression) compared to OAB patients without pelvic pain., Conclusion: A subset of OAB patients has pain inside and/or outside the pelvis. The intensity and distribution of pain in OAB was intermediate between IC/BPS and controls. Systemic processes such as central sensitization should be examined in this population., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: To document patient-reported interstitial cystitis/bladder pain syndrome (IC/BPS) flare management strategies and triggers., Materials and Methods: Twenty-four male and 29 female participants enrolled at the Washington University site of the MAPP Research Network completed a questionnaire on strategies they utilized to manage flares and factors they believed triggered their flares (eg, specific food items, physical activities, sexual activities, infections, and stress). Participants were also asked about the diurnal timing of their flares., Results: A total of 96.2% of participants reported having ever experienced a symptom flare. Participants treated or managed their flares using a wide variety of strategies, ranging from common strategies, such as drinking additional water or fluid (74.5%), to less common strategies, such as acupuncture/acupressure (5.9% of participants). Participants also reported a wide range of perceived flare triggers, including previously reported factors (citrus fruits, tomatoes, spicy food, alcoholic and caffeinated beverages, driving/sitting in forms of transportation, urinary tract infections, stress, and tight clothing), as well as some less common, previously undocumented factors (eg, certain foods, nongenitourinary infections, wearing high-heeled shoes/boots or perfume, hair dye, and toothpaste). In general, female participants and those with somatic sensory hypersensitivity reported greater numbers of therapies and triggers. Finally, flares were reported most commonly in the afternoon or evening., Conclusion: IC/BPS participants reported diverse flare management strategies and numerous perceived triggers. These findings, together with those from the small body of literature to date, provide a wide array of candidates and hypotheses for future global and tailored flare management and prevention interventions., (Copyright © 2019. Published by Elsevier Inc.)

Objective: To identify avoidable predictors of postureteroscopy (URS) unplanned encounters and to minimize 30-day encounters., Materials and Methods: We performed retrospective chart review and telephone surveys on patients who underwent URS for urolithiasis between January and June 2016. Univariate and multivariable analyses evaluated for potential predictors of unplanned encounters., Results: Of 157 patients, there were 44 (28.0%) unplanned patient-initiated clinical phone calls, 23 (14.6%) emergency department (ED) visits, and 8 (5.1%) readmissions, with pain being the most common complaint during the encounters. Factors associated with a higher rate of phone calls include first-time stone procedure (36.6% vs 20.9%, p = 0.029), outpatient status (30.3% vs 0%, p = 0.021), intraoperative stent placement (31.2% vs 0%, p = 0.006), and stent removal at home (58.8% vs 28.8%, p = 0.014). Factors associated with increased rate of ED visits were first-time stone procedure (22.5% vs 8.1%, p = 0.011) and ureteral access sheath (UAS) usage (29.6% vs 11.8%, p = 0.018). Factors associated with a higher rate of readmissions were lower body mass index (23.9 vs 29.7, p = 0.013), bilateral procedure (20.0% vs 2.9%, p = 0.010), and UAS usage (14.8% vs 3.1%, p = 0.032). Stone burden, operative time, Charlson comorbidity index, and preoperative urinary tract infection were not significantly associated with postoperative encounters., Conclusions: Pain, first-time stone treatment, presence of a ureteral stent, outpatient status, bilateral procedures, and UAS usage were common reasons for postoperative encounters after URS. Appropriate perioperative patient education and counseling and adequate pain management may minimize these encounters and improve treatment quality and patient satisfaction.

Purpose: Wolfram syndrome is a neurodegenerative disorder characterized by childhood onset diabetes mellitus, optic nerve atrophy, diabetes insipidus, hearing impairment, and commonly bladder and bowel dysfunction. We hypothesized that there is an association between a smaller pons, which contains the pontine micturition center, and abnormal lower urinary tract function., Materials and Methods: Patients with genetically confirmed Wolfram syndrome attended an annual multidisciplinary research clinic. Subjects underwent noninvasive urodynamic testing and brain magnetic resonance imaging, and completed validated patient reported outcome measures. Bowel and bladder diaries were completed before visits. Age and gender corrected linear and logistic mixed effects models were used to correlate pons volume, corrected for whole brain size, to urodynamic and patient reported outcomes., Results: A total of 36 patients attended 142 visits between 2010 and 2016. Mean age was 16.9 years (range 7 to 30) and 64% of patients were female. Functional bladder capacity was decreased in 31% of the patients, normal in 54% and increased in 14%. Of the patients 44% and 54% had abnormal uroflowmetry and post-void residual, respectively, on at least 1 occasion. There was no increase through time in incidence of lower urinary tract dysfunction. Decreased pons volume was associated with increased post-void residual (p = 0.048) and higher PinQ (Pediatric Incontinence Questionnaire) score (p = 0.011), indicating lower quality of life and higher levels of dysfunction., Conclusions: A significant number of children, adolescents and young adults with Wolfram syndrome have objective evidence of lower urinary tract dysfunction. Decreased pons volume is associated with more abnormal urinary function and lower quality of life in patients with Wolfram syndrome., (Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Aims: To compare severity and characteristics of urologic pain, other urinary symptoms, sexual pain, psychosocial health, and the distribution and intensity of non-urologic pain between men and women with and without Hunner lesions., Methods: All cystoscopies were performed and documented by the same clinician to ensure uniform recognition of Hunner lesions. Intensity of urologic and sexual pain, nocturia, frequency, urgency, and bladder hypersensitivity features were assessed using validated questionnaires and numeric rating scales. The distribution and intensity of non-urologic pain was assessed using self-reported history, a body map diagram, and numeric rating scales. Somatic symptom burden, depression, and anxiety were compared., Results: Among the 150 participants, 27% (n = 41) had Hunner lesions (36% of men, 25% of women). Participants with Hunner lesions were significantly older (median age 58 vs 41, P < 0.001). They reported less intense urologic pain (5 vs 7, P = 0.024) and more nocturia (ICSI nocturia symptom score: 4 vs 3, P = 0.007). They also were less likely to have a history of irritable bowel syndrome (15% vs 36%, P = 0.013) and anxiety attacks (22% vs 44%, P = 0.013). Close to half of Hunner IC patients had non-urologic pain outside the pelvis. There were no differences in bladder hypersensitivity features (eg, painful bladder filling) between the two groups., Conclusions: Hunner lesions can be identified in both men and women. There are significant overlaps in terms of their urologic and non-urologic presentation. Further investigation is needed on phenotypic and biological distinction between IC/BPS with and without Hunner lesions., (© 2018 Wiley Periodicals, Inc.)

Purpose: Pelvic floor abnormalities often affect multiple organs. The incidence of concomitant uterine/vaginal prolapse with rectal prolapse is at least 38%. For these patients, addition of sacrocolpopexy to rectopexy may be appropriate. Our aim was to determine if addition of sacrocolpopexy to rectopexy increases the procedural morbidity over rectopexy alone., Methods: We utilized the ACS-NSQIP database to examine female patients who underwent rectopexy from 2005 to 2014. We compared patients who had a combined procedure (sacrocolpopexy and rectopexy) to those who had rectopexy alone. Thirty-day morbidity was compared and a multivariable model constructed to determine predictors of complications., Results: Three thousand six hundred patients underwent rectopexy; 3394 had rectopexy alone while 206 underwent a combined procedure with the addition of sacrocolpopexy. Use of the combined procedure increased significantly from 2.6 to 7.7%. Overall morbidity did not differ between groups (14.8% rectopexy alone vs. 13.6% combined procedure, p = 0.65). Significant predictors of morbidity included addition of resection to a rectopexy procedure, elevated BMI, smoking, wound class, and ASA class. After controlling for these and other patient factors, the addition of sacrocolpopexy to rectopexy did not increase overall morbidity (OR 1.00, p = 0.98)., Conclusions: There is no difference in operative morbidity when adding sacrocolpopexy to a rectopexy procedure. Despite a modest increase in utilization of combined procedures over time, the overall rate remains low. These findings support the practice of multidisciplinary evaluation of patients presenting with rectal prolapse, with the goal of offering concurrent surgical correction for all compartments affected by pelvic organ prolapse disorders.

In the interest of renal functional preservation, partial nephrectomy has supplanted radical nephrectomy as the preferred treatment for T1 renal masses. This procedure usually involves the induction of renal warm ischemia by clamping the hilar vessels prior to tumor excision. Performing robot-assisted partial nephrectomy (RAPN) "off-clamp" can theoretically prevent renal functional loss associated with warm ischemia. We describe our institutional experience and compare perioperative and renal functional outcomes using a propensity score matched cohort. We conducted a retrospective comparison from a prospectively maintained database of all patients who underwent RAPN from 2009 to 2015. Of those patients, 143 underwent off-clamp RAPN. Fifty off-clamp RAPN patients were propensity score matched with fifty clamped RAPN patients based on renal function, tumor size, and R.E.N.A.L. nephrometry score. The cohorts were compared across demographics, operative information, perioperative outcomes, and renal functional outcomes. For all off-clamp RAPN patients, mean nephrometry score was 7.1, mean estimated blood loss (EBL) was 236.9 mL, perioperative complication rate was 7.7%, and mean decrease in estimated glomerular filtration rate (eGFR) was 7.1% at a median follow-up of 9.2 months. In the propensity score matched cohorts, off-clamp RAPN resulted in a shorter mean operative time (172.0 versus 196.0 min, p = 0.025) and a lower mean EBL (179.7 versus 283.2 mL, p = 0.046). A lower complication rate of 6.0% in the off-clamp group compared with 20.0% in the clamped group approached significance (p = 0.071). Mean preoperative eGFR was similar in both cohorts. Importantly, there was no significant difference in decrease in eGFR between the clamped cohort (9.8%) and off-clamp cohort (11.9%) at a median follow-up of 9.0 months (p = 0.620). Off-clamp RAPN did not result in improved renal functional preservation in our experience. Surprisingly, the off-clamp cohort experienced lower intraoperative blood loss, shorter operative times, and fewer complications.

Before many of the global environmental knowledge producing networks and technologies emerged later in the twentieth century, another spatially extended form of field science was implemented at a continental scale by the U.S. Bureau of Biological Survey, revealing similar tensions and dynamics. Specimens and observations from across continental spaces were integrated through railroad-based transportation and communications networks in order to map distributions of birds and mammals and delineate "life zones" stretching across the continent. At the same time that field zoologists of the Biological Survey produced this cosmopolitan scientific knowledge, they also developed an intimate, experiential knowledge of many of the places where they traveled. By following the travels of Biological Survey field parties, especially the agency's long-time chief field naturalist Vernon Bailey, during the late nineteenth and early twentieth centuries when the railroad was dominant, this paper traces the interconnections between the two ways of knowing in the Biological Survey's practice. However, the integration of these different forms of knowledge was ultimately partial and incomplete, as seen through the Survey's daily practices such as food consumption, the seasonality of survey field practice, and limitations on what types of knowledge were incorporated from lay network collaborators and field assistants., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objective: To determine whether an enhance recovery protocol for radical cystectomy patient affected the length of stay or the number and type of readmissions that occurred after hospital discharge., Materials and Methods: We prospectively assessed 152 cystectomy patients after initiation of the pathway. These patients were compared with the previous 147 patient operated on before the pathway initiation. Eligible patients were those undergoing radical cystectomy with any diversion at our institution. Univariate tests were performed using Wilcoxon sum-rank and chi-square tests. Multivariate analyses were performed using logistic regression models to assess for patient factors related to readmissions., Results: With institution of the pathway, length of stay decreased from 10 to 7.1 days. Our readmission rates did not change significantly. Patients were readmitted for different reasons after pathway implementation, with the rate of urinary tract infection-related readmissions increasing from 14.3% to 40.4%, but with a concomitant decrease in the rate of readmissions for wound and deep space infections from 42.9% to 23.4%. Our venous thromboembolism rate decreased from 6.8% to 3.3% with implementation of the protocol., Conclusion: Implementation of a cystectomy care pathway significantly decreased length of stay without an increased rate of readmissions at 30 days. No patient factors predisposed to an increased rate of readmission. Pathway implementation led to a decrease in wound and deep space infection readmissions, but was associated with an increase in urinary tract infection readmissions. Further studies are examining if early intervention can further decrease readmission rates., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Since the early days of modern neuroscience, psychological models of brain function have been a key component in the development of new knowledge. These models aim to provide a framework that allows the integration of discoveries derived from the fundamental disciplines of neuroscience, including anatomy and physiology, as well as clinical neurology and psychiatry. During the initial stages of his career, Sigmund Freud (1856-1939), became actively involved in these nascent fields with a burgeoning interest in functional neuroanatomy. In contrast to his contemporaries, Freud was convinced that cognition could not be localised to separate modules and that the brain processes cognition not in a merely serial manner but in a parallel and dynamic fashion-anticipating fundamental aspects of current network theories of brain function. This article aims to shed light on Freud's seminal, yet oft-overlooked, early work on functional neuroanatomy and his reasons for finally abandoning the conventional neuroscientific "brain-based" reference frame in order to conceptualise the mind from a purely psychological perspective.

Task interspersal is a teaching method frequently used with individuals with autism spectrum disorder (ASD). Although many different procedural variations of task interspersal have been reported in the literature, it is unclear how providers serving individuals with ASD implement task interspersal. The present study surveyed direct care providers to examine which variations of task interspersal they use most frequently, as well as how they choose a particular variation. Results revealed that many different procedural variations are used across providers. Provider discipline background appeared to be associated with differences in selection of specific procedural variations. Findings inform areas for further research as well as consideration of topics for discussion during training and/or supervision with employees and trainees. (1) Providers report frequently interspersing tasks of similar difficulty, despite research supporting the practice of interspersing tasks of varying difficulty. Service providers might consider primarily implementing maintenance among acquisition tasks when using task interspersal. (2) Due to potential problems associated with using the same reinforcement schedules/reinforcers for both tasks (e.g., satiation), providers and supervising BCBAs are encouraged to consider whether using different reinforcement schedules/reinforcers will enhance acquisition outcomes. (3) When selecting a procedural variation, providers reported relying on clinical judgment or guidelines from their organizations more frequently than directly contacting the current literature. It is important that organizations and supervisors provide clear guidelines and recommendations based on the most recent scientific literature and update these as new research is published. (4) Individualization of procedures based on specific client characteristics was found to be inconsistent. Supervisors are encouraged to discuss individualization practices for cases in which consistency of treatment across providers is preferred or necessary for maintenance of skills., Competing Interests: The authors declare that there is no conflict of interest.All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.Informed consent was obtained from all individual participants included in the study.

Purpose: For high-risk prostate cancer (HR-PCa) in men with a life expectancy of at least 10 years, the National Comprehensive Cancer Network recommends radiation therapy (RT) plus androgen deprivation therapy (ADT) with category 1 evidence or radical prostatectomy (RP) as an acceptable initial therapy. Randomized evidence regarding which therapy is optimal for disease control is lacking for men with HR-PCa. We performed a propensity-score-matched comparison of outcomes for men with localized HR-PCa treated with primary RT or RP., Methods and Materials: The medical records of patients with localized HR-PCa who were treated at our institution between 2002 and 2011 were reviewed. Patient and disease characteristics, treatment details, and outcomes were collected. A combination of nearest-neighbor propensity score matching on age, Adult Comorbidity Evaluation-27 comorbidity index, prostate-specific antigen, biopsy Gleason scores, and clinical T-stage as well as exact matching on prostate-specific antigen, biopsy Gleason scores, and clinical T-stage was performed. Outcomes were measured from diagnosis. Multivariate Cox proportional hazards regression was used to compare metastasis-free and overall survival., Results: A total of 246 patients were identified with 62 propensity-score-matched pairs. ADT was administered to 6.5% and 80.6% of patients receiving RP and RT, respectively. Five-year rates of metastasis for RP and RT were 33% and 8.9%, respectively ( P  = .003). Overall survival was not different. Delay of salvage therapy was longer for patients undergoing primary RT ( P  < .001). Findings were similar when only those patients who did not receive ADT were compared., Conclusions: At our institution, treatment with primary RT resulted in superior metastasis-free survival over RP. This was not accompanied by an improvement in OS.