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Simple Summary: Leukemia history affects some radical prostatectomy (RP) patients. While its prevalence and impact as an adverse risk factor are well-known in cardiac surgery, the number of RP patients with a leukemia history and their rate of adverse in-hospital outcomes are unknown. We identified RP patients with a leukemia history in a large-scale database. Patients with a leukemia history had higher rates of acute kidney injury, more frequent dialysis, and extended hospital stays compared to those without a leukemia history. Introduction: Leukemia history affects some radical prostatectomy (RP) patients. Although its prevalence and effect as an adverse risk factor are well known in cardiac surgery, the number of RP patients with a leukemia history, as well as their rate of adverse in-hospital outcomes, are unknown. Methods: We identified RP patients (National Inpatient Sample 2000–2019), stratified according to the presence or absence of a leukemia history. Descriptive analyses, propensity score matching (PSM, ratio 1:10), and multivariable logistic regression models were used. Results: Of 259,939 RP patients, 416 (0.2%) had a leukemia history. Their proportion increased from 0.1 to 0.2% covering the study span (p < 0.01). Leukemia history patients were older (median age, 64 vs. 62 years, p < 0.001). After PSM for age, insurance status, ethnicity, pelvic lymph node dissection, and Charlson Comorbidity Index, leukemia history RP patients exhibited higher rates of acute kidney injury (<2.6 vs. 0.9%; Odds Ratio [OR] 2.0, p = 0.02), more frequently underwent dialysis (3.6 vs. 1.9%; OR 1.9, p = 0.03), and more frequently had a length of stay exceeding one week (4.8 vs. 2.5%; OR 2.0, p = 0.006). Conclusions: Although leukemia history RP patients are rare, their numbers have increased. Renal complications and extended hospital stays are more frequent in those individuals. [ABSTRACT FROM AUTHOR]

Background: In contemporary surgically treated patients with localized high-grade (G3 or G4) clear-cell renal cell carcinoma (ccRCC), it is not known whether presence of sarcomatoid dedifferentiation is an independent predictor and/or an effect modifier, when cancer-specific mortality (CSM) represents an endpoint. Methods: Within the Surveillance, Epidemiology, and End Results database, all surgically treated localized high-grade ccRCC patients treated between 2010 and 2020 were identified. Univariable and multivariable Cox-regression models were used. Results: In 18,853 surgically treated localized high-grade (G3 or G4) ccRCC patients, 5-year CSM-free survival was 87% (62% vs. 88% with vs. without sarcomatoid dedifferentiation, p < 0.001). Presence of sarcomatoid dedifferentiation was an independent predictor of higher CSM (hazard ratio [HR] 1.8, p < 0.001). In univariable survival analyses predicting CSM, presence versus absence of sarcomatoid dedifferentiation in G3 versus G4 yielded the following hazard ratios: HR 1.0 in absent sarcomatoid dedifferentiation in G3; HR 2.7 (p < 0.001) in absent sarcomatoid dedifferentiation in G4; HR 3.9 (p < 0.001) in present sarcomatoid dedifferentiation in G3; HR 5.1 (p < 0.001) in present sarcomatoid dedifferentiation in G4. Finally, in multivariable Cox-regression analyses, the interaction terms defining present versus absent sarcomatoid dedifferentiation in G3 versus G4 represented independent predictors of higher CSM. Conclusions: In contemporary surgically treated patients with localized high-grade ccRCC, sarcomatoid dedifferentiation is not only an independent multivariable predictor of higher CSM, but also interacts with tumor grade and results in even better ability to predict CSM. [ABSTRACT FROM AUTHOR]

Background: In-hospital mortality and complication rates after partial and radical nephrectomy in patients with history of heart-valve replacement are unknown. Patients and Methods: Relying on the National Inpatient Sample (2000–2019), kidney cancer patients undergoing partial or radical nephrectomy were stratified according to presence or absence of heart-valve replacement. Multivariable logistic and Poisson regression models addressed adverse hospital outcomes. Results: Overall, 39,673 patients underwent partial nephrectomy versus 94,890 radical nephrectomy. Of those, 248 (0.6%) and 676 (0.7%) had a history of heart-valve replacement. Heart-valve replacement patients were older (median partial nephrectomy 69 versus 60 years; radical nephrectomy 71 versus 63 years), and more frequently exhibited Charlson comorbidity index ≥ 3 (partial nephrectomy 22 versus 12%; radical nephrectomy 32 versus 23%). In partial nephrectomy patients, history of heart-valve replacement increased the risk of cardiac complications [odds ratio (OR) 4.33; p < 0.001), blood transfusions (OR 2.00; p < 0.001), intraoperative complications (OR 1.53; p = 0.03), and longer hospital stay [rate ratio (RR) 1.25; p < 0.001], but not in-hospital mortality (p = 0.5). In radical nephrectomy patients, history of heart-valve replacement increased risk of postoperative bleeding (OR 4.13; p < 0.001), cardiac complications (OR 2.72; p < 0.001), intraoperative complications (OR 1.53; p < 0.001), blood transfusions (OR 1.27; p = 0.02), and longer hospital stay (RR 1.12; p < 0.001), but not in-hospital mortality (p = 0.5). Conclusions: History of heart-valve replacement independently predicted four of twelve adverse outcomes in partial nephrectomy and five of twelve adverse outcomes in radical nephrectomy patients including intraoperative and cardiac complications, blood transfusions, and longer hospital stay. Conversely, no statistically significant differences were observed in in-hospital mortality. [ABSTRACT FROM AUTHOR]

Simple Summary: External beam radiation therapy with or without systemic chemotherapy is a well-established treatment modality in patients with non-metastatic localized or locally advanced rectosigmoid cancer, with improved cancer control and survival rates. However, it has been previously extensively demonstrated that there is an association between radiation exposure and the risk of radiation-induced malignances. Specifically, previous studies demonstrated the increased risk of bladder cancer after radiation therapy for rectal cancer relative to radiation-unexposed counterparts. However, these studies relied on historical cohorts and also relied on more historical radiation delivery techniques. Moreover, only one of these studies addressed bladder cancer-specific survival rates in patients with bladder cancer after rectal cancer according to previous radiation exposure for rectal cancer. The aim of this study was to evaluate the effect of radiation therapy for rectal cancer on risk of subsequent bladder cancer relative to radiation-unexposed counterparts, relying on the most contemporary cohort of patients. We ascertained that although historical radiation therapy for rectal cancer predisposed patients to higher subsequent bladder cancer rates, contemporary external beam radiation therapy for rectal cancer is not associated with increased subsequent bladder cancer risk. Moreover, when bladder cancer after rectal cancer occurs, bladder cancer-specific mortality rates are not affected by previous radiation exposure for rectal cancer. Background: Historical external beam radiation therapy (EBRT) for rectosigmoid cancer (RCa) predisposed patients to an increased risk of secondary bladder cancer (BCa). However, no contemporary radiotherapy studies are available. We addressed this knowledge gap. Materials and methods: Within the Surveillance, Epidemiology, and End Results database (2000–2020), we identified non-metastatic RCa patients who either underwent radiotherapy (EBRT+) or did not (EBRT-). Cumulative incidence plots and multivariable competing risk regression models (CRR) were fitted to address rates of BCa after RCa. In the subgroup of BCa patients, the same methodology addressed BCa-specific mortality (BCSM) according to EBRT exposure status. Results: Of the 188,658 non-metastatic RCa patients, 54,562 (29%) were EBRT+ vs. 134,096 (73%) who were EBRT-. In the cumulative incidence plots, the ten-year BCa rates were 0.7% in EBRT+ vs. 0.7% in EBRT- patients (p = 0.8). In the CRR, EBRT+ status was unrelated to BCa rates (multivariable HR: 1.1, p = 0.8). In the subgroup of 1416 patients with BCa after RCa, 443 (31%) were EBRT+ vs. 973 (69%) who were EBRT-. In the cumulative incidence plots, the ten-year BCSM rates were 10.6% in EBRT+ vs. 12.1% in EBRT- patients (p = 0.7). In the CRR, EBRT+ status was unrelated to subsequent BCSM rates (multivariable HR: 0.9, p = 0.9). Conclusion: Although historical EBRT for RCa predisposed patients to higher BCa rates, contemporary EBRT for RCa is not associated with increased subsequent BCa risk. Moreover, in patients with BCa after RCa, exposure to EBRT does not affect BCSM. [ABSTRACT FROM AUTHOR]

Background: Biochemical recurrence (BCR) represents the rise of prostate-specific antigen (PSA) levels after treatment with curative radical prostatectomy (RP) or radiation for prostate cancer. The objective of the current study was to test for the association between patient characteristics, namely age, body mass index (BMI), as well as prostate volume at surgery, and BCR after RP. Material and Methods: Within a tertiary care database, patients with prostate cancer treated with RP between January 2014 and June 2023 were included. Kaplan–Meier survival analyses and Cox regression models addressed BCR after RP according to patient characteristics. Results: Of 821 patients, the median age was 66 years (interquartile range [IQR] 61–71 years), BMI was 26.2 kg/m2 (IQR 24.3–28.8 kg/m2), and prostate volume was 40 cm3 (IQR 30–55 cm3). Median follow-up was 20 months. In survival analyses, the three-year BCR-free survival rates were 81 vs. 84 vs. 81% in patients aged ≤60 vs. 61–69 vs. 70 years (p = 0.1). In patients with BMI < 25.0 vs. 25.0–29.9 vs. ≥30.0 kg/m2, the three-year BCR-free survival rates were 84 vs. 81 vs. 84% (p = 0.7). In patients with prostate volume ≤40 vs. >40 cm3, the three-year BCR-free survival rates were 85 vs. 80% (p = 0.004). In multivariable Cox regression models accounting for patient and pathologic tumor characteristics and adjuvant radiation therapy, a higher prostate volume independently predicted BCR as continuous (hazard ratio 1.012, 95% confidence interval 1.005–1.019; p < 0.001), as well as categorized the variable based on the median (hazard ratio 1.66, 95% confidence interval 1.17–2.36; p = 0.005). Conversely, neither age nor BMI were significantly associated with BCR after RP. Conclusions: The higher prostate volume independently predicted BCR after RP, but not age or BMI at surgery. Consequently, patients with an elevated prostate volume should be considered for closer postoperative follow-up. [ABSTRACT FROM AUTHOR]

Introduction We assessed the association of genitourinary microbiomes with prostate cancer (PCa) tumorigeneses and cancer characteristics. Material and methods A systematic search and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The primary endpoints were the association between relative abundance of genitourinary microbiomes and PCa compared to non-cancerous men/prostate specimen, high grade disease, and disease progression. The odds ratio (OR) was used as the summary statistic, and results were reported with 95% condence intervals (CI). Results Seventeen studies, comprising 2,195 patients were eligible for review and meta-analysis. The specific microbiomes in urine, prostate tissue, and prostate (or seminal) secretions were significantly more abundant in patients with PCa compared to men in the control groups in individual studies. Certain bacterial phyla, genuses, and species were significantly associated with PCa aggressiveness and disease progression in individual studies. The relative abundance meta-analysis of five urine microbiomes revealed no statistically significant differences between PCa patients and control groups (pooled OR, 1.35; 95% CI: 0.70–2.59). Conclusions Our systematic review indicates that specific genitourinary microbiomes are more abundant in PCa and have a potential to predict/prognosticate disease aggressiveness and clinical outcomes. Nevertheless, these findings should be interpreted with caution owing to the significant heterogeneity among studies in terms of microbiome analysis method, assessed sample’s characteristics, and individual biological behavior of microbiomes for analysis. Further studies are needed to validate these observations and shed more light on the role of the microbiome across the development and natural history of PCa. [ABSTRACT FROM AUTHOR]

ContextDespite excellent cancer control with the treatment of localized prostate cancer (PCa), some men will experience a recurrence of disease. The optimal management of recurrent disease remains uncertain.ObjectiveTo systematically review recent literature regarding management of biochemical recurrence after primary treatment for localized PCa.Evidence acquisitionA comprehensive systematic review of the literature was performed from 2000 to 2012 to identify articles pertaining to management after recurrent PCa. Search terms included prostate cancer recurrence, salvage therapy, radiorecurrent prostate cancer, post HIFU, post cryoablation, postradiation, and postprostatectomy salvage. Studies were selected according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines and required to provide a comprehensive description of primary and secondary treatments along with outcomes.Evidence synthesisThe data from 32 original publications were reviewed. The most common option for local salvage therapy after radical prostatectomy (RP) was radiation. Options for local salvage therapy after primary radiation included RP, brachytherapy, and cryotherapy. Different definitions of recurrence and risk profiles among patients make comparative assessment among salvage treatment modalities difficult. Triggers for intervention and factors predicting response to salvage therapy vary.ConclusionsRadiation therapy (RT) after RP can provide durable prostate-specific antigen (PSA) responses in a sizeable percentage of men, especially when given early (ie, PSA