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Purpose To assess the incidence, risk factors, and clinical outcomes associated with (Clostridioides difficile infection) CDI following urological surgery, which is the leading cause of nosocomial diarrhea and a growing public health burden. Methods We queried the National Surgical Quality Improvement Program (NSQIP) to identify patients undergoing urological surgery in 2015–2016. We evaluated the 30-day incidence and factors associated with postoperative CDI and 30-day hospital readmission and length of stay as secondary outcomes. Among the subset of patients undergoing radical cystectomy with urinary diversion (surgery with highest CDI incidence) we used multivariable logistic regression analysis to evaluate independent clinical and demographic factors associated with postoperative CDI. Results We identified 98,463 patients during the study period. The overall 30-day incidence of CDI was 0.31%, but varied considerably across surgery type. The risk of CDI was greatest following radical cystectomy with urinary diversion (2.72%) compared to all other urologic procedures (0.19%) and was associated with increased risk of hospital readmission (p

INTRODUCTION AND OBJECTIVE:To compare time to prostate cancer (PC) progression with enzalutamide (ENZA) vs active surveillance (AS) in patients (pts) with low- or intermediate-risk localized PC.MET...

INTRODUCTION AND OBJECTIVE:Small cell bladder cancer is associated with highly aggressive clinical behavior and poor long-term survival. Nonetheless, in patients with clinically localized disease, ...

To assess the impact of patient age and weight on the pharmacokinetics (PK), testosterone (T) suppression and safety from four fixed dosing regimens (7.5, 22.5, 30, or 45 mg for 1-, 3-, 4-, or 6-months, respectively) of subcutaneous in situ gel delivered leuprolide acetate (Gel-LA) injected via the ATRIGEL Delivery System in patients with prostate cancer (PCa).Two patient populations were specified for analysis: a small cohort of surgically castrated PCa patients and a large, pooled population of PCa patients from four pivotal trials of Gel-LA. Two separate analyses of the impact of age and weight on study endpoints were conducted: (1) PK and safety of a single monthly dose of Gel-LA in a Phase 1 study with PCa patients who had undergone bilateral surgical orchiectomy ("Bilaterally orchiectomized male study"); (2) PK/pharmacodynamic (PD) effects and safety using pooled data from four pivotal trials assessing 1-, 3-, 4-, and 6-month dosing of Gel-LA in patients with advanced PCa, stratified by age and body weight (pivotal trials).Eight orchiectomized patients from the "Bilaterally orchiectomized male study" and 438 patients from the pivotal trials were included in the analyses. Age and body weight did not appear to affect the PK results in the orchiectomized patient population. Pooled pivotal trial data showed that serum T levels did not appear to be influenced by age or weight; ≥90% of patients across all age groups and ≥92% of patients across all weight groups achieved T ≤ 50 ng/dL by week 4. Median T levels for castration (T ≤ 50 ng/dL) were maintained from week 3 until the end of the study and all subgroups achieved median T ≤ 20 ng/dL by week 4. Patients from the orchiectomized patient study did not report any serious treatment-related adverse events (AEs) and there were no AE-related withdrawals from the study. The most common AEs were hot flashes and injection site events. The safety profiles from pivotal trials have been previously described and, as expected, were consistent with known effects of LHRH agonist therapy and suppression of T levels.PK and PD of Gel-LA appear to be unaffected by age and body weight, as demonstrated by persistence of effective drug levels through the dosing period and consistent T suppression across different ages and body weights.

The incremental morbidity of lymph node dissection (LND) among men undergoing radical prostatectomy remains uncertain. We therefore evaluated the association of LND with perioperative morbidity among men undergoing minimally invasive radical prostatectomy (MIRP). We identified 29,012 men aged 35–89 who underwent MIRP from 2010–2015 in the National Surgical Quality Improvement Program (NSQIP) database, of whom 47% underwent concomitant LND. The associations of LND with 30-day perioperative morbidity and mortality were evaluated using logistic regression, adjusted for patient features. Median age at surgery was 63 (IQR 57, 67) years. There were statistically significant, but clinically insignificant, differences in several baseline characteristics stratified by performance of LND, including older age at surgery (p

Prostate cancer (PC) is primarily a disease of older men. As the risk of neurocognitive decline increases as people age, cognitive dysfunction is a potential complication in men with PC, imposing detrimental effects on functional independence and quality of life. Importantly, risk of cognitive decline may increase with exposure to androgen deprivation therapy and other hormonal therapies. Particular consideration should be given to patients with castration-resistant PC (CRPC), many of whom require continuous, long-term androgen deprivation therapy combined with a second-generation androgen receptor inhibitor. Non-comparative evidence from interventional trials of androgen receptor inhibitors in men with non-metastatic CRPC suggests differential effects on cognitive function and central nervous system-related adverse events within this drug class. Drug-drug interactions with concomitant medications for chronic, non-malignant comorbidities differ among ARIs and thus may contribute further to cognitive impairment. Hence, establishing baseline cognitive function is a prerequisite to identifying subsequent clinical decline associated with androgen receptor-targeted therapies. Although brief, sensitive screening tools for cancer-related cognitive dysfunction are lacking, mental status can be ascertained from the initial medical history and neurocognitive examination, progressing to more in-depth evaluation when impairment is suspected. On-treatment neurocognitive monitoring should be integrated into regular clinical follow-up to preserve cognitive function and quality of life throughout disease management. This review summarizes the multiple factors that may contribute to cognitive decline in men with CRPC, awareness of which will assist clinicians to optimize individual treatment. Practical, clinic-based strategies for managing the risks for and symptoms of cognitive dysfunction are also discussed.

Introduction: Clinical care pathways reduce length of stay, variability in practice and costs, yet avoid compromising quality of care or increasing complications. In this study we describe a standardized care pathway, focusing on preoperative and postoperative education as well as immediate postoperative patient care after robotic assisted laparoscopic radical prostatectomy.Methods: A standardized robotic assisted laparoscopic radical prostatectomy care pathway was introduced at our institution in July 2014. A total of 108 men who underwent robotic assisted laparoscopic radical prostatectomy during 2014 were enrolled in this retrospective chart review and were subsequently mailed a quality of life survey. Data regarding length of stay and number of unplanned calls to the urology office or visits to the emergency department were collected from the chart review. The mailed survey was composed of original questions as well as questions adapted from the FACT-P (Functional Assessment of Cancer Therapy-...

Recommendations for prostate cancer treatment include weight loss, but the most efficacious diet has not been determined. Men on active surveillance or with untreated biochemical relapse consumed both the diet recommended by the Prostate Cancer Foundation (PCF) and a plant-based that included three tablespoons of extra virgin olive oil per day for 8 weeks of weight loss and improvement in some laboratory biomarkers with random assignment to the diet order. They then selected one of the diets for six months of follow-up. Thirty men started the protocol and 18 completed the 44 week study. Mean age: 66.6 ± 5.9 years; baseline body mass index: 30.9 ± 2.7 kg/m2. Weight loss was comparable between the diets after 8 weeks (PCF: 2.5% ± 3.1% v olive oil: 2.8% ± 3.7%; p = 0.86), but the diet that included olive oil resulted in lower insulin (PCF: 13.7 ± 7.0 mU/L v olive oil: 11.5 ± 4.4 mU/L; p = 0.02), glucose (PCF: 104.9 ± 9.9 mg/dl v 99.1 ± 9.6 mg/dl; p = 0.01), and HOMA-IR (PCF: 3.6 ± 2.1 v olive oil: 2.9 ± 1.2; p = 0.02). Thirteen of the 18 men choose the olive oil diet for six months of follow-up and weight loss and lab improvements were maintained. This pilot study indicates that both the PCF diet and the plant-based diet that included extra virgin olive oil can produce similar weight loss short-term. However, a plant-based diet that includes extra virgin olive may be more acceptable for long-term use, and produce better glycemic control.

Prostate cancer management changed in recent times given the recommendation against prostate-specific antigen screening, adherence to active surveillance, and "cytoreductive" surgery. We hypothesized that radical prostatectomy (RP) findings changed as well. All consecutive RPs (n=1348) and first time prostate needle biopsies (n=1719) in a period of 9 years were reviewed. The cohort was separated into 3 groups: (1) from May 2006 to April 2009, (2) from May 2009 to April 2012, and (3) from May 2012 to April 2015. The number of RPs decreased 15% from 551 in group 1 to 476 in group 2 and decreased a further 35% to 311 in group 3. Pure Gleason 6 (grade group 1) decreased from 46% in group 1 to 24% in group 2 (P

INTRODUCTION AND OBJECTIVE:Pelvic lymph node dissection (LND) is an integral component of the surgical treatment of invasive urothelial carcinoma of the bladder. Although an extended surgical templ...

Background: Multiple new systemic agents have been targeted to metastatic prostate cancer, with decreased progression of disease but no cure. Surgical management of metastatic disease has been gaining interest, primarily in the setting of high-risk prostatectomies. However, metastasis-directed surgical intervention has been employed in rare scenarios, especially in oligometastatic disease. We report here on a salvage robot-assisted pelvic lymph node dissection for a solitary metastatic site. Case Presentation: A 63-year-old Hispanic man who was initially treated with prostatectomy for intermediate risk cancer developed rapid biochemical recurrence. After salvage radiation, fluciclovine positron emission tomography (PET)/computed tomography (CT) scan showed a solitary pelvic lymph node metastasis. A robot-assisted laparoscopic pelvic lymph node dissection was carried out, with subsequent nadir of his prostate-specific antigen at 0.026. Conclusion: To our knowledge, this is the first report of salvage pelvic lymph node dissection after metastatic detection by fluciclovine PET/CT scan. Our patient experienced a complete biochemical response; however, it remains to be seen whether this will be a lasting response. Surgical resection of metastatic sites in prostate cancer offers a safe alternative to systemic therapy and avoids systemic side effects.

AIM : Prostate specific antigen (PSA) is a widely utilized screening marker for prostate cancer. Its performance in detecting prostate cancer is enhanced with the 5α-reductase inhibitor (5aRI) dutasteride. We evaluated if PSA density velocity (PSADV) further improved the ability to predict prostate cancer risk on repeat biopsy utilizing the REDUCE trial data in order to avoid unnecessary biopsies. MATERIALS AND METHODS : The REDUCE study randomized 8 231 men aged 50 to 75 years with a PSA between 2.5 and 10 ng/mL and a previously benign prostate biopsy. Prostate volume, PSA and biopsy results at 24 months were available for 1 074 subjects. PSADV, defined as the change in PSA density divided by the number of days between PSA measurements (ng/mL/cc/day), was calculated and compared between the placebo and treatment groups and further stratified by prostate biopsy results. Statistical significance was calculated using the Wilcoxon rank sum test. RESULTS : Median PSA, PSA velocity, and PSADV are shown for the placebo and dutasteride treatment cohorts at 24 months in Table 1. Median PSA velocity in both the placebo and treatment groups were positive independent of a prostate cancer diagnosis. Results of PSADV stratified by treatment and biopsy results are seen in the boxplots in Figure 1. There was a significantly more robust reduction in PSADV in those without cancer on biopsy compared to those with prostate cancer in the treatment arm (P = 0.0019). CONCLUSIONS : The magnitude of change in PSADV after dutasteride therapy may be an additional diagnostic adjunct to aid in the identification of those at lower risk for prostate cancer on repeat biopsy. This measurement may reduce unnecessary prostate biopsies and the increasingly prevalent associated risks of the procedure.

321 Background: Sip-T is an FDA approved, autologous cellular immunotherapy for mCRPC, manufactured by activating peripheral blood mononuclear cells collected by apheresis and culturing them with PA2024 (PAP fused to human GM-CSF). Overall survival (OS) in mCRPC is positively correlated with key product parameters of sip-T: CD54 upregulation; CD54+ cell count; and total nucleated cell (TNC) count. Product parameters were amplified in men with earlier stage prostate cancer vs mCRPC, including increased T cell trafficking to the prostate (Fong L, JNCI 2014) and greater CD54 upregulation and larger immune responses (Antonarakis ES, Clin Can Res 2017). Methods: ProVENT (NCT03686683) will evaluate sip-T in men with Gleason grade 1/2 prostate adenocarcinoma receiving active surveillance (target, 450 men; randomized 2:1 to receiving sip-T or not). We evaluated apheresis and final key product parameters (CD54 upregulation; CD54+ cell count; and TNC count) for each infused product as well as cumulative values while also comparing with IMPACT (NCT00065442) study results. Results: This preliminary analysis describes data from the first 184 sip-T men in ProVENT. CD54 upregulation profiles were consistent between IMPACT and ProVent, peaking in week 2 products; however, values at each treatment week, and subsequently cumulative CD54 upregulation, were statistically significantly higher for ProVENT (P

A twenty-eight-year-old female with a history of suprapubic pain and recurrent urinary tract infections presents for urology referral with a kidney, ureter, and bladder radiograph showing a 4.4 cm bladder calculus and 6.5 cm distal left ureteral stone. She underwent effective cystolitholapaxy of the bladder stone. Endourologic attempt (left ureteroscopy) was unsuccessful because of ureteral stone burden. Findings at ureteroscopy revealed a duplicated system on the left with the lower pole moiety joining just proximal to the ureteral orifice. The stone was found to be in the upper pole moiety ureter. An open ureterolithotomy was performed with intraoperative ureteroscopic laser lithotripsy and common sheath ureteral reimplant. Furthermore, a previously placed stent was found to be encrusted at the time of the ureterolithotomy. Effective ureteroscopy and lasering were performed through the ureterotomy up to the renal pelvis of the upper pole ureter.

Nonmetastatic castration-resistant prostate cancer (nmCRPC) presents a challenge to urologists as currently there are no Food and Drug Administration-approved therapies. However, there are new imaging modalities, including fluciclovine positron emission tomography-computed tomography and Ga-PSMA (prostate specific membrane antigent) positron emission tomography-computed tomography, which are improving accuracy of diagnosis. With improved imaging, we are better able to target therapy. Today there are 3 ongoing clinical trials studying second-generation antiandrogens in nmCRPC, which hold the promise of a new treatment paradigm. In this article, we will review the new imaging techniques and the rationale behind novel treatment modalities in nmCRPC.

In recent years, there has been a shift to minimally invasive partial nephrectomy (MIPN) with the dissemination of robot-assisted technology. However, contemporary data on the comparative morbidity of open partial nephrectomy (OPN) and MIPN are lacking. We, therefore, evaluated the perioperative morbidity of OPN and MIPN using a contemporary national cohort.We identified 13,658 patients aged 18 to 89 who underwent PN from 2010 to 2015 in the National Surgical Quality Improvement Program (NSQIP) database, of whom 9018 (66.0%) underwent MIPN. The associations of MIPN with 30-day morbidity were evaluated using logistic regression, adjusted for patient features.Median age at surgery was 60 (interquartile range [IQR] 51, 68) years. Overall, 30-day complications occurred in 6.7% of patients. Compared with OPN, MIPN was associated with lower rates of 30-day complications (4.9% vs 10.1%, p 0.0001), perioperative blood transfusion (3.8% vs 12.5%, p 0.0001), prolonged hospitalization (5.6% vs 23.4%, p 0.0001), readmission (4.4% vs 7.8%, p 0.0001), reoperation (1.8% vs 3.2%, p 0.0001), and 30-day mortality (0.3% vs 0.6%, p = 0.001). On multivariable analysis, MIPN was independently associated with a reduced risk of 30-day complications (odds ratio [OR] 0.46, p 0.0001), perioperative blood transfusion (OR 0.27, p 0.0001), prolonged hospitalization (OR 0.19, p 0.0001), readmission (OR 0.59, p 0.0001), and reoperation (OR 0.57, p 0.0001). Postoperative complications occurred predominantly early after surgery, whereas hospital readmissions and reoperation occurred at a consistent rate.In this contemporary national cohort, MIPN was independently associated with reduced rates of 30-day complications, perioperative blood transfusion, prolonged hospitalization, hospital readmission, and reoperation, compared with OPN.

Gonorrhea and chlamydia are sexually transmitted infections (STI) that are the most common causes of urethritis in men. The role of specific sexual behaviors and presentation of urethritis is often overlooked.Data was retrospectively reviewed on all men presenting at the major STI clinic in Providence, Rhode Island. Predictors of gonorrhea and chlamydia infection were modeled using a generalized model assuming a binary distribution.Of the men with urethritis, 27% had chlamydia, 13% gonorrhea, 3% both, and 63% neither (non-gonococcal, non-chlamydial urethritis). MSM were more likely to test positive for gonorrhea than MSW (25% of MSM versus 6% of MSW; p0.01).MSM with urethritis were much more likely to test positive for gonorrhea which may be due to increased risk behaviors and spread within concentrated sexual networks. A large number of both MSM and MSW had non-gonococcal, non-chlamydial urethritis, which suggests the need for improved diagnostic testing. [Full article available at http://rimed.org/rimedicaljournal-2016-06.asp, free with no login].

Extracellular vesicles (EV) are small membrane-bound vesicles enriched in a selective repertoire of mRNA, miRNA, proteins and cell surface receptors from parental cells and are actively involved in the transmission of inter and intracellular signals. Cancer cells produce EV that contain cargo including DNA, mRNA, miRNA and proteins that allow EV to create epigenetic changes in target cells both locally and systemically. Cancer-derived EV play critical roles in tumorigenesis, cancer cell migration, metastasis, evasion of host immune defense, chemoresistance, and they promote a premetastatic niche favourable to micrometastatic seeding. Their unique molecular profiles acquired from originator cells and their presence in numerous body fluids, including blood and urine, make them promising candidates as biomarkers for prostate, renal and bladder cancers. EV may ultimately serve as targets for therapy and as platforms for personalized medicine in urology. As urologic malignancy comprises 28% of new solid tumour diagnoses and 15% of cancer-related deaths, EV-related research is rapidly emerging and providing unique insights into disease progression. In this report, we review the current literature on EV in the setting of genitourinary fertility and malignancy. Keywords: extracellular vesicles; genitourinary fertility and malignancy; prostasomes; prostate, renal and bladder cancer; biomarkers (Published: 30 June 2015) Citation: Journal of Extracellular Vesicles 2015, 4: 23815 - http://dx.doi.org/10.3402/jev.v4.23815

Joseph F Renzulli II, Jennifer Collins, Anthony Mega Genitourinary Multidisciplinary Clinic, The Miriam Hospital, Providence, RI, USAAbstract: Improving options for patients with metastatic castration-resistant prostate cancer (mCRPC) provide latitude in designing treatment plans that meet patients' medical needs and personal goals. The field's rapid evolution opens avenues for contributions by multiple medical specialties and requires considering more options to ensure that each patient receives the most appropriate care. A multidisciplinary clinic (MDC) focusing on patients with cancers of the genitourinary tract demonstrates an efficient and cost-effective means of integrating the diverse professional knowledge and skills needed to develop an optimal patient treatment plan. As a guide to establishing an MDC for patients with mCRPC, this article describes the operation of the Genitourinary MDC at The Miriam Hospital in Providence, RI – specifically, the successful incorporation of radium-223 dichloride (radium-223) into the treatment algorithm for men with mCRPC and symptomatic bone metastases. Radium-223 is a new treatment that, unlike earlier radionuclide therapies, has shown a survival advantage in a large randomized phase 3 trial (ALSYMPCA). The overall survival benefit was comparable to that of newer immuno- and hormonal therapies in similar populations. Radium-223 treatment also delayed onset of symptomatic skeletal events. Both benefits were independent of prior docetaxel therapy or concurrent bisphosphonate use. In our clinic, radium-223 is used primarily to extend patient survival. Patient selection, patient management, and treatment sequencing are discussed here in the context of a multidisciplinary environment. Keywords: radium-223 dichloride, prostate cancer, castration-resistant prostate cancer, multidisciplinary clinic, best practices

Objective To examine the effect of rectal swab culture–directed prophylaxis on the incidence of prostate biopsy–associated infections. Secondary objectives were to determine the rate of fluoroquinolone resistance and extended-spectrum beta-lactamase production in local rectal flora. Methods All men receiving prostate biopsies from February 2013 to February 2014 were included in a retrospective institutional review board–approved study. All received either a preprocedural rectal swab and culture-directed antimicrobial prophylaxis or routine fluoroquinolone antibiotics. Clinical information was collected on infectious complications treated within 30 days of biopsy. Chi-square test, Fisher exact test, and Welch t test were used for statistical analysis. Confounding variables were included in a multivariate logistic regression model. Results Of 487 total patients, 314 received preprocedure rectal cultures and 173 did not. Average ages were 62.7 and 64.1 years, respectively (P = .07). There was no difference in mean prostate-specific antigen value (P = .9), Charlson comorbidity score (P = .8), or ethnicity (P = .1). The rectal swab group was more likely to receive supplemental gentamicin (P < .001) and had fewer infectious complications (1.9% vs 2.9%; P = .5). On multivariate analysis, decreased odds of infection was associated with culture-directed antibiotics (odds ratio, 0.70; 95% confidence interval, 0.20-2.50; P = .6). However, the study was only powered to detect a 97% reduction in infections. The incidence of fluoroquinolone resistance and extended-spectrum beta-lactamase production was 12.1% and 0.64%, respectively. Conclusion Our study was underpowered but suggests that there are lower odds of infection with rectal swab–directed antimicrobial prophylaxis. The local incidence of fluoroquinolone resistance is high. A prospective, randomized, controlled trial is warranted to further evaluate this intervention.

Purpose. Atypical small acinar proliferation (ASAP) is diagnosed in 1-2% of prostate biopsies. 30–40% of patients with ASAP may be diagnosed with prostate cancer (PCa) on repeat biopsy. Our objective was to examine the association between ASAP and subsequent diagnosis of intermediate/high risk PCa.Materials and Methods. Ninety-six patients who underwent prostate biopsy from 2000 to 2013 and were diagnosed with ASAP were identified. Clinicopathologic features were analyzed. Comparison was made between those with subsequent PCa on repeat biopsy and those with benign repeat pathology.Results. 56/96 (58%) patients had a repeat biopsy. 22/56 (39%) were subsequently diagnosed with PCa. There was no significant difference in patients’ characteristics. Presence of HGPIN on initial biopsy was associated with a benign repeat biopsy (68% versus 23%). 17/22 (77%) had Gleason grade (GG) 3+3 disease and only 5/22 (23%) had GG 3+4 disease.Conclusions. 22/56 patients (39%) of patients who underwent a subsequent prostate biopsy following a diagnosis of ASAP were found to have PCa. 77% of these men were diagnosed with GG 3+3 PCa. Only 23% were found to have intermediate risk PCa and no high risk PCa was identified. Immediate repeat prostate biopsy in patients diagnosed with ASAP may be safely delayed. A multi-institutional cohort is being analyzed.

O Modelo de Enriquecimento para toda a Escola (SEM) e amplamente implementado como um programa de enriquecimento utilizado com estudantes superdotados e talentosos academicamente e uma abordagem de enriquecimento geral para todas as escolas interessadas em desenvolver os pontos fortes e talentos de todos os educandos. O principal objetivo do SEM e a aplicacao da pedagogia educacional para alunos superdotados ao enriquecimento total da escola e a uma aprendizagem desfrutavel. O SEM proporciona experiencias de aprendizagem enriquecidas e padroes de aprendizagem mais elevados para todas as criancas por meio de tres objetivos: desenvolver talentos em todas as criancas, oferecer uma ampla gama de experiencias de enriquecimento para todos os estudantes e proporcionar oportunidades de acompanhamento em nivel avancado para os jovens com base em seus pontos fortes e interesses. O SEM focaliza o enriquecimento para todos os estudantes por meio de elevados niveis de engajamento e o uso de experiencias de aprendizagem desfrutaveis e desafiadoras que sao construidas em torno dos interesses, estilos de aprendizagem e modos de expressao preferidos dos estudantes.

Older age is considered a relative contraindication to radical prostatectomy (RP). However, data are limited regarding the impact of age on perioperative outcomes following RP. We examined the association of age with perioperative outcomes following RP to inform risk-stratification and management.We identified 35,968 men aged 18 to 89 years who underwent RP from 2010 to 2015 in the National Surgical Quality Improvement Program (NSQIP) database. The associations of age with 30-day complications and perioperative morbidity were evaluated using logistic regression, adjusted for patient features. Age was modeled both as a categorical and nonlinear continuous variable.Median age at surgery was 63 years (IQR: 58-67). Increasing age was associated with greater rates of perioperative morbidity. Compared to men aged60 years, men aged 70 to 89 years had statistically significantly higher rates of 30-day complications (6.4% vs. 4.4%, P0.0001), perioperative blood transfusion (6.0% vs. 3.7%, P0.0001), readmission (4.9% vs. 3.9%, P0001), and 30-day mortality (0.3% vs. 0.1%, P0.0001). In multivariable analyses, older age was independently associated with increased risks of perioperative morbidity. Moreover, there was a nonlinear relationship of age with perioperative morbidity, wherein rates of 30-day complications, perioperative blood transfusion, and readmission increased after approximately 70 years of age.In this national cohort, we observed a nonlinear association of age with perioperative morbidity, with increasing rates of 30-day complications, perioperative blood transfusion, and readmission after approximately 70 years of age. These results have implications for risk-stratification, patient counseling, and treatment selection among older men.

Background: Currently, there are multiple commercially available RNA-based biomarkers that are Medicare approved and suggested for use by the National Comprehensive Cancer Network guidelines. There is uncertainty as to which patients benefit from genomic testing and for whom these tests should be ordered. Here, we examined the correlation patterns of Decipher assay to understand the relationship between the Decipher and patient tumor characteristics. Methods: De-identified Decipher test results (including Decipher risk scores and clinicopathologic data) from 2 342 consecutive radical prostatectomy (RP) patients tested between January and September 2015 were analyzed. For clinical testing, tumor specimen from the highest Gleason grade was sampled using a 1.5 mm tissue punch. Decipher scores were calculated based on a previously locked model. Correlations between Decipher score and clinicopathologic variables were computed using Spearman's rank correlation. Mixed-effect linear models were used to study the association of practice type and Decipher score. The significance level was 0.05 for all tests. Results: Decipher score had a positive correlation with pathologic Gleason score (PGS; r=0.37, 95% confidence interval (CI) 0.34−0.41), pathologic T-stage (r=0.31, 95% CI 0.28−0.35), CAPRA-S (r=0.32, 95% CI 0.28−0.37) and patient age (r=0.09, 95% CI 0.05-0.13). Decipher reclassified 52%, 76% and 40% of patients in CAPRA-S low-, intermediate- and high-risk groups, respectively. We detected a 28% incidence of high-risk disease through the Decipher score in pT2 patients and 7% low risk in pT3b/pT4, PGS 8−10 patients. There was no significant difference in the Decipher score between patients from community centers and those from academic centers (P=0.82). Conclusions: Although Decipher correlated with baseline tumor characteristics for over 2 000 patients, there was significant reclassification of tumor aggressiveness as compared to clinical parameters alone. Utilization of the Decipher genomic classifier can have major implications in assessment of postoperative risk that may impact physician-patient decision making and ultimately patient management.

Objective To determine if the quality of prescreening discussions has changed following release of the United States Preventive Services Task Force statement against prostate cancer screening. Methods This cross-sectional study used the 2012 and 2014 Behavioral Risk Factor Surveillance System surveys. Respondents were categorized based on the year in which they responded to the Behavioral Risk Factor Surveillance System Survey. Quality of prescreening discussion was operationalized as having discussed only advantages, only disadvantages, both advantages and disadvantages, or neither. Race/ethnicity, education level, income, insurance status, and having a prostate-specific antigen (PSA) level actually drawn after prescreening counseling served as confounders in our multivariate analysis. Results Among 217,053 men in the analytic sample, 37% were told about only advantages of PSA screening compared to 30% of men who were advised about both advantages and disadvantages. Men who were told about neither advantages nor disadvantages were more likely to be Hispanic, not graduate high school, have low income, and not have insurance. Controlling for covariates, men in 2014 were significantly more likely to have undergone PSA testing without having discussed either advantages or disadvantages than men in 2012. Conclusion Comprehensive prescreening discussions about advantages and disadvantages of PSA testing are critical to informed decision making about prostate cancer screening. Disparities not only exist with regard to the quality of prescreening discussions that patients receive from their providers prior to PSA testing across categories of race/ethnicity, education, income, and insurance status, but these disparities became more substantial between 2012 and 2014. Further investigation is warranted to elicit more specific reasons behind these variations.

Prostate cancer (PCa) is the most common solid tumor in males and the second leading cause of cancer-related deaths in males in the United States. The current first line therapy for metastatic PCa is androgen deprivation therapy and is initially effective against the disease. However, castrate resistant prostate cancer (CRPC) develops in many men within 18-36 months, rendering this treatment ineffective. Chemotherapy, with a class of drugs known as taxanes is the standard-of-care cytotoxic option in metastatic castrate resistant PCa (mCRPC). However, the overall survival advantage for chemotherapy in mCRPC is only 2.2 months and the cancer cells often become resistant to these drugs as well. Once patients fail chemotherapy the progression to death is inevitable. Extracellular vesicles (EVs) are involved in cell signaling and play a role in cancer progression. Previous work has demonstrated that EVs are involved in the development of drug resistance in cancer cells. We report the reversal of taxane resistance and tumorigenic phenotype in PCa cells after EVs treatment. This study suggests that EVs represent a potentially novel therapeutic treatment option for CRPC.