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• W4292589969 abstract "You have accessJournal of UrologyThis Month in Adult Urology1 Nov 2022This Month in Adult Urology D. Robert Siemens D. Robert SiemensD. Robert Siemens More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002912AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Who Benefits From Adjuvant Radiation After Prostatectomy? There remains some equipoise in the role of adjuvant radiotherapy (aRT) after prostatectomy for those with adverse pathology, compared to observation and early salvage, as there was a dearth of these patients in the standard setting randomized trials. More recent retrospective reports suggest there may be an advantage of aRT for those at highest risk of recurrence. But which patients specifically would benefit? Mazzone et al (page 1046) from Italy address this gap, comparing the strategies in a retrospective single-center study including 926 eligible patients with adverse pathology (ie, Grade group 4-5, ≥pT3a stage and/or lymph node invasion) and stratify their risk to predict subgroups who may benefit from aRT compared to an early salvage approach.1 They identified 3 subclassifications of risk within those with adverse pathology. Survival analyses did not show any difference in 10-year overall survival in their low- and intermediate-risk cases, suggesting early observation may still be appropriate. In those classified as “high risk,” aRT was associated with significant improvement in survival compared to observation ± early salvage radiotherapy and these patients may be most appropriate to move forward with a more aggressive adjuvant approach. Associations of Urinary Conditions and Unmet Social Needs As clinicians we should be more aware of the complex interplay between urinary conditions and unmet social needs. Sebesta et al (page 1106) from Nashville, Tennessee add insight to these under-investigated questions, exploring social determinants of health and their relationships with overactive bladder (OAB).2 Utilizing a large population of men and women recruited to complete a questionnaire online, the authors report multiple associations with overactive bladder including fear of losing utilities, transportation to health care appointments, housing safety and quality, food insecurity, health care costs, and stress about home plumbing. Despite the limitations of a cross-sectional survey, and one with a relatively homogenous and predominantly white population, the authors’ observations underscore that which we, experientially, recognize to be a common concern when we talk with many of our patients with urinary symptoms. The question moving forward is how we best help them more holistically, compared to a unidimensional, biological approach. This manuscript at least allows us to be better equipped to ask those questions and begin to understand the importance of these social constructs and their intersections with bladder conditions. Factors Leading to Conversion for Partial to Radical Nephrectomy Tsivian et al (page 960) from Rochester, Minnesota, from a single-center prospectively collected data set, present the largest case-control study evaluating patient and tumor factors that might help predict the need for conversion from partial to radical nephrectomy.3 Given past conflicting reports, this is a significant unmet need, as having a better understanding of the variables that might influence chance of conversion are important to provide patients more accurate expectations of potential outcomes. Although the requirement for conversion decreased over time, on multivariable analyses male sex, comorbidities, and posterior and middle (on anteroposterior axis) as well as hilar location were associated with conversion, even after adjusting for tumor size. The authors’ observations provide surgeons some much needed clarity in the factors that could influence surgical planning and, in certain cases, may even influence treatment modality. Financial Toxicity and Prostate Cancer Care Cost of cancer care continues to rise dramatically as newer molecular and immune therapies have revolutionized management. At issue is cost sharing plans in certain jurisdictions that for some cancer patients and survivors has led to financial toxicity, decreased treatment adherence, and impacts on quality of life. Joyce et al (page 987) from Rochester, Minnesota and Nashville, Tennessee evaluated the out-of-pocket (OOP) costs for >13,000 commercially insured patients with advanced prostate cancer between 2007 and 2019.4 Unsurprisingly, those receiving novel hormonal therapy had the highest treatment-related ($4,236 in the first year) and overall health care OOP costs compared to those who received androgen deprivation monotherapy alone or chemotherapy. Beyond exposing this financial burden, the authors explore factors associated with high OOP, costs which is critical to develop strategies to help mitigate this contribution to the well described disparities in the care of prostate cancer. Genetic Counseling by Urological Care Givers Germline mutations have been identified in up to 17% of men with prostate cancer. Several pathogenic variants may drive disease severity, and may be targets for novel therapies, leading to more recent guidelines expanding the role of germline testing for those with advanced disease. With limited access to genetic counselors, how can the urological community best address the expanded need for counseling for those patients with prostate cancer? Abusamra et al (page 1007) from Ann Arbor, Michigan report the results of a prospective study of having nongenetic counselor clinicians provide pre- and post-test counseling to 275 men with prostate cancer.5 The study included 18 urologists or medical oncologists who received training prior to the study to deliver counselling to patients as part of their routine clinical care. The results of the study showed that 203 (74%) patients elected to undergo genetic testing with a high rate of satisfaction of the counselling itself. The authors conclude that genetic counseling can be successfully offered by urological care givers, and, with appropriate training, this approach could help expand the uptake of germline genetic testing for men with prostate cancer. References 1. Not all adverse pathology features are equal: identifying optimal candidates for adjuvant radiotherapy among patients with adverse pathology at radical prostatectomy. J Urol. 2022; 208(5):1046-1055. Link, Google Scholar 2. . Associations between unmet social needs and overactive bladder. J Urol. 2022; 208(5):1106-1115. Link, Google Scholar 3. Unplanned conversion from partial to radical nephrectomy: an analysis of incidence, etiology, and risk factors. J Urol. 2022; 208(5):960-968. Link, Google Scholar 4. Out-of-pocket cost burden associated with contemporary management of advanced prostate cancer among commercially insured patients. J Urol. 2022; 208(5):987-996. Link, Google Scholar 5. Satisfaction with clinician-led germline genetic counseling in patients with prostate cancer. J Urol. 2022; 208(5):1007-1017. Link, Google Scholar © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 208Issue 5November 2022Page: 945-946 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information D. Robert Siemens More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ..." @default.
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