Care For Prostate Cancer Patients Research Articles

PRO-P: evaluating the effect of electronic patient-reported outcome measures monitoring compared with standard care in prostate cancer patients undergoing surgery-study protocol for a randomized controlled trial.

With over 65,000 new cases per year in Germany, prostate cancer (PC) is the most common cancer in men in Germany. Localized PC is often treated by radical prostatectomy and has a very good prognosis. Postoperative quality of life (QoL) is significantly influenced by the side effects of surgery. One possible approach to improve QoL is postoperative symptom monitoring using ePROMs (electronic patient-reported outcome measures) to accurately identify any need for support. The PRO-P ("Influence of ePROMS in surgical therapy of PC on the postoperative course") study is a randomized controlled trial employing 1:1 randomization at 6weeks postoperatively, involving 260 patients with incontinence (≥ 1 pad/day) at six participating centers. Recruitment is planned for 1year with subsequent 1-year follow-up. PRO-monitoring using domains of EPIC-26, psychological burden, and QoL are assessed 6, 12, 18, 24, 36, and 52weeks postoperatively. Exceeding predefined PRO-score cutoffs triggers an alert at the center, prompting patient contact, medical consultation, and potential interventions. The primary endpoint is urinary continence. Secondary endpoints refer to EPIC-26 domains, psychological distress, and QoL. Aspects of feasibility, effect, and implementation of the intervention will be investigated within the framework of a qualitative process evaluation. PRO-P investigates the effect on postoperative symptom monitoring of a structured follow-up using ePROMs in the first year after prostatectomy. It is one of the first studies in cancer surgery investigating PRO-monitoring and its putative applicability to routine care. Patient experiences with intensified monitoring of postoperative symptoms and reflective counseling will be examined in order to improve primarily urinary continence, and secondly other burdens of physical and psychological symptoms, quality-of-life, and patient competence. The potential applicability of the intervention in clinical practice is facilitated by IT adaption to the certification standards of the German Cancer Society and the integration of the ePROMs survey via a joint patient portal. Positive outcomes could readily translate this complex intervention into routine clinical care. PRO-P might improve urinary incontinence and QoL in patients with radical prostatectomy through the structured use of ePROMs. ClinicalTrials.gov NCT05644821. Registered on 09 December 2022.

The 30th Annual Prostate Cancer Foundation Scientific Retreat Report.

The 30th Annual Prostate Cancer Foundation (PCF) Scientific Retreat was held at the Omni La Costa Resort in Carlsbad, CA, from October 26 to 28, 2023. A hybrid component was included for virtual attendees. The Annual PCF Scientific Retreat is a leading international scientific conference focused on pioneering, unpublished, and impactful studies across the spectrum of basic through clinical prostate cancer research, as well as research from related fields with significant potential for improving prostate cancer research and patient outcomes. The 2023 PCF Retreat concentrated on key areas of research, including: (i) the biology of cancer stem cells and prostate cancer lineage plasticity; (ii) mechanisms of treatment resistance; (iii) emerging AI applications in diagnostic medicine; (iv) analytical and computational biology approaches in cancer research; (v) the role of nerves in prostate cancer; (vi) the biology of prostate cancer bone metastases; (vii) the contribution of ancestry and genomics to prostate cancer disparities; (viii) prostate cancer 3D genomics; (ix) progress in new targets and treatments for prostate cancer; (x) the biology and translational applications of tumor extracellular vesicles; (xi) updates from PCF TACTICAL Award teams; (xii) novel platforms for small molecule molecular glues and binding inhibitors; and (xiii) diversity, equity and inclusionstrategies for advancing cancer care equity. This meeting report summarizes the presentations and discussions from the 2023 PCF Scientific Retreat. We hope that sharing this information will deepen our understanding of current and emerging research and drive future advancements in prostate cancer patient care.

Genomic Testing Helps Personalize Care for Prostate Cancer Patients

Genomic Testing Helps Personalize Care for Prostate Cancer Patients

Improving Prostate Cancer Patient Care in the Clinical Setting.

At JADPRO Live 2023 in Orlando, presenters provided an overview of best practices in the diagnosis, classification, and management of patients with localized and metastatic prostate cancer. They covered selecting appropriate therapies based on patient clinical presentation and treatment goals, as well as managing side effects and interventions for modifiable health risks in patients with prostate cancer.

Optimization and scale up of production of the PSMA imaging agent [18F]AlF-P16-093 on a custom automated radiosynthesis platform

BackgroundRecent advancements in positron emission tomograph (PET) using prostate specific membrane antigen (PSMA)-targeted radiopharmaceuticals have changed the standard of care for prostate cancer patients by providing more accurate information during staging of primary and recurrent disease. [68Ga]Ga-P16-093 is a new PSMA-PET radiopharmaceutical that demonstrated superior imaging performance in recent head-to-head studies with [68Ga]Ga-PSMA-11. To improve the availability of this new PSMA PET imaging agent, [18F]AlF-P16-093 was developed. The 18F-analog [18F]AlF-P16-093 has been synthesized manually at low activity levels using [18F]AlF2+ and validated in pre-clinical models. This work reports the optimization of the production of > 15 GBq of [18F]AlF-P16-093 using a custom automated synthesis platform.ResultsThe sensitivity of the radiochemical yield of [18F]AlF-P16-093 to reaction parameters of time, temperature and reagent amounts was investigated using a custom automated system. The automated system is a low-cost, cassette-based system designed for 1-pot syntheses with flow-controlled solid phase extraction (SPE) workup and is based on the Raspberry Pi Zero 2 microcomputer/Python3 ecosystem. The optimized none-decay-corrected yield was 52 ± 4% (N = 3; 17.5 ± 2.2 GBq) with a molar activity of 109 ± 14 GBq/µmole and a radiochemical purity of 98.6 ± 0.6%. Run time was 30 min. A two-step sequence was used: SPE-purified [18F]F− was reacted with 80 nmoles of freeze-dried AlCl3·6H2O at 65 °C for 5 min followed by reaction with 160 nmoles of P16-093 ligand at 40 °C for 4 min in a 1:1 mixture of ethanol:0.5 M pH 4.5 NaOAc buffer. The mixture was purified by SPE (> 97% recovery). The final product formulation (5 mM pH 7 phosphate buffer with saline) exhibited a rate of decline in radiochemical purity of ~ 1.4%/h which was slowed to ~ 0.4%/h when stored at 4 °C.ConclusionThe optimized method using a custom automated system enabled the efficient (> 50% none-decay-corrected yield) production of [18F]AlF-P16-093 with high radiochemical purity (> 95%). The method and automation system are simple and robust, facilitating further clinical studies with [18F]AlF-P16-093.

(013) How do Sexual Medicine Specialists Handle Patient Counseling and Penile Rehabilitation in Patients Undergoing Robotic Assisted Radical Prostatectomy (ralp): Trends in Pre Op and Post Operative Management

Abstract Introduction Guidelines for Sexual Health Care for Prostate Cancer Patients: Recommendations of an International Panel has been published in Journal of Sexual Medicine in late 2022. However, evaluation and treatment in this subset of patients appears to be variable and not evidence driven. Objective The objective of our study was to poll sexual medicine specialists regarding their current evaluation and treatment of sexual dysfunction before and after RALP. Methods 22 sexual medicine specialists took a questionnaire at the time of the SMSNA/ISSM meeting in the fall of 2022. Queries were made regarding the demographics of the specialists, their pre operative evaluation, guidance and treatments, and the nature of their referral base. Information was also collected regarding pre operative questions about multiple sexual parameters such as ejaculation, penile curvature, erectile function, climacturia and any initiation of pre op therapies. Post operative questionnaire data included timing of initial evaluation, therapeutic recommendations and likelihood and timing of post operative recovery of function. Results 23 responses were collected. 100% of respondents were SMSNA members, 8 (34.8%) were ISSM members. 22 (95.7%) had a subspecialty practice in sexual medicine. 100% were located in North America. A majority of respondents (19/23, 82.6%) had between 2-10 prostate surgeons in their practice. 9 (39.1%) reported that those surgeons routinely sent patients for preoperative optimization; 4 (17.4%) reported that none did so. 7 (31.8%) regularly counseled patients preoperatively about the risk of ejaculatory pain, 11 (47.8%) about the risk of climacturia, 16 (69.6%) about the risk of penile length loss, 17 (73.9%) about the risk of significant erectile dysfunction, and 7 (30.4%) about the risk of penile curvature. 22 (95.7%) cautioned patients that they would most likely need medication to assist with erectile function postoperatively. For preoperative optimization, 12 (54.5%) respondents regularly recommend preoperative PDE5is, 7 (30.4%) regularly recommend a vacuum erection device, and 3 (13%) recommend pelvic floor rehabilitation. Postoperatively, 13 (56.5%) recommend a vacuum device postoperatively, another 3 (13%) sometimes do so, and 19 (82.6%) encouraged patients to start PDE5is immediately postoperatively. 19 (82.6%) continued PDE5is after 3 months without spontaneous erections. 17 (73.9%) recommended Tadalafil 5mg daily, others used Sildenafil at varying doses. 15 (65.2%) respondents believed that penile rehabilitation made a difference in outcomes at 2 years. Another 5 (21.7%) were unsure, but had enough data to continue with their protocol. Conclusions Despite new guidelines for evaluation and treatment of patients undergoing RALP, there appears to be diverse counseling, recommendations and treatment both preoperatively and postoperatively. Evidence based and expert opinion guidelines may alter pre operative counseling and treatment in the future. Disclosure No.

Current status of PSMA-targeted imaging and therapy.

Currently, the incidence of prostate cancer is increasing, and it has become a great threat to men's health. The detection, staging, and follow-up of prostate cancer patients are inseparable from morphology or magnetic resonance imaging (MRI). However, these do not fully meet the needs of diagnosis and patient management. In particular, owing to the late diagnosis, metastatic castration-resistant prostate cancer (mCRPC) patients usually have poor survival and few options for further effective treatment. Prostate-specific membrane antigen (PSMA), because of its overexpression on prostate cancer cells, has gained interest due to its application in the imaging and theranostics field. Several PSMA radioligands have been developed for imaging and treating prostate cancer. Many clinical trials have assessed the efficacy and safety profiles of these radionuclide agents and show promise in patients who have exhausted other standard treatment options. To date, several small compounds for targeting PSMA have been developed, and 68Ga-PSMA-11 and 18F-DCFPyL have been approved by the United States (US) Food and Drug Administration (FDA) for imaging of prostate cancer. 111In- or 99mTc-labeled PSMA-ligand can guide surgeons searching for radioactive metastatic lymph nodes, and 177Lu- or 225Ac-labeled PSMA-ligand can be used for internal radiotherapy. Moreover, some molecules for therapeutic application are undergoing different stages of clinical trials. In this review, we present current perspectives on the use of PSMA-targeted imaging and theranostics in prostate cancer. As PSMA-targeted imaging and therapeutics are becoming the standard of care for prostate cancer patients, we emphasize the importance of integrating nuclear medicine physicians into multidisciplinary oncology teams.

Current Status and Future Direction to Address Disparities in Diversity, Equity, and Inclusion in Prostate Cancer Care.

Disparities in prostate cancer care and outcomes have been well recognized for decades. The purpose of this review is to methodically highlight known racial disparities in the care of prostate cancer patients, and in doing so, recognize potential strategies for overcoming these disparities moving forward. Over the past few years, there has been a growing recognition and push towards addressing disparities in cancer care. This has led to improvements in care delivery trends and a narrowing of racial outcome disparities, but as we highlight in the following review, there is more to be addressed before we can fully close the gap in prostate cancer care delivery. While disparities in prostate cancer care are well recognized in the literature, they are not insurmountable, and progress has been made in identifying areas for improvement and potential strategies for closing the care gap.

Retracted: Clinical Efficacy and Psychological Impact of Omaha-Based Continuing Care for Prostate Cancer Patients.

[This retracts the article DOI: 10.1155/2022/8735363.].

Abstract B128: The effect of insurance status on age of prostate cancer mortality

Abstract Background: Prostate cancer is one of the leading causes of cancer death among men [1]. Therefore, it is imperative that patients have adequate access to timley oncologic care [2]. However, access to timely diagnosis and care for prostate cancer patients may be affected by insurance status [3]. Here we investigate if insurance status is associated with worse mortality for prostate cancer patients. Methods: This study utilizes the National Longitudinal Mortality Study (NLMS) database, which includes 745,162 records of patients who were interviewed in April 2002 and followed up for 6 years in the United States [4]. We extracted all records of men for whom “malignant neoplasms of the prostate” was indicated as the cause of mortality. This search yielded 1434 records of men who died within the six years following their interview. 726 of these patients did not have a record of their insurance status. We stratified the remaining 708 patients by insurance type and compared their ages at death. The different insurance types included Medicare (79.3%), Medicaid (0.4%), non-Medicare non-Medicaid government healthcare (1.8%), employer (14.7%), and private coverage (3.7%). We performed an unpaired t-test to compare the age at death of the patients with and without health insurance in the calendar year prior to the interview. We also calculated the Hedges’ g to estimate the effect size [5]. Statistical significance in the mean age of mortality among insured patients was assessed with ANOVA followed by Tukey-Kramer's multiple comparison test [6].Results: The mean age of mortality for prostate cancer patients without insurance is 66.03 years, which is significantly lower than the mean age of 71.63 years for prostate cancer patients who have insurance (p<0.0003). The effect-size estimates suggest that having insurance of any kind results in decreased mortality significantly. The differences in ages of mortality between insurance types were significant (p<0.001) with patients with Medicare having the highest mean age of mortality of 74.66 years compared to other four groups that were included in the study. The rest of the groups that were compared using the intergroup analysis in the study did not have a significant difference in mortality age among them with exception of the comparison between employer-based coverage and private coverage with private coverage having significantly higher mean mortality age of 65.44 (p<0.0001).Conclusion: Insured patients with prostate cancer had longer life expectancy than prostate cancer patients without insurance. This leads to the hypothesis that patients with financial limitations may have worse outcomes relating to prostate cancer diagnosis, treatment and mortality [7]. Further research is needed to evaluate why Medicare-insured have significantly higher mean age of mortality when compared to other groups of insurance types. Citation Format: Zuhair Sadiq, Shahryar Rana, Abdullah Memon, Ramiz Memon, Henry Park. The effect of insurance status on age of prostate cancer mortality [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B128.

Restored Thymic Output after Androgen Blockade Participates in Antitumor Immunity.

The thymus is a hormone-sensitive organ, which involutes with age in response to production of sex steroids. Thymic involution leads to a decrease in the generation of recent thymic emigrants (RTEs), resulting in a reduced response to immune challenges such as cancer. Interestingly, the standard of care for prostate cancer patients is androgen deprivation therapy (ADT), which leads to thymic regeneration and an increase in thymic output. It remains unknown whether these newly produced T cells can contribute to the antitumor immune response. This study defines the kinetics of thymic regeneration in response to ADT in mice, determining that thymic epithelial cell proliferation is critical for the increase in RTE output. Using a mouse model to track RTE in vivo, we demonstrate that these newly generated RTEs can traffic to tumors, where they become activated and produce effector cytokines at levels similar to more mature T cells. Collectively, these data suggest that RTEs produced from ADT-induced thymic regeneration could be harnessed for the antitumor immune response.

Evaluation einer Prostatakrebsnachsorge-App aus Patientensicht: Eine qualitative Studie

IntroductionThe project “Digital unterstützte Prostatakrebsnachsorge in Schleswig-Holstein” (Digitally supported prostate cancer aftercare in Schleswig-Holstein) funded by the federal state of Schleswig-Holstein aims to test the app “Nachsorge-Pass” (Patient Aftercare Book) in the care of prostate cancer patients after seed brachytherapy. In order to evaluate the app from the patient perspective a qualitative study was conducted which examined usability, usefulness and potential for improvement. MethodsAll patients using the app at the start of the study were invited to participate in semi-structured telephone interviews; 12 of 20 users (60%) followed the invitation. In addition, the questionnaire “System Usability Scale” (SUS) was applied. Qualitative content analysis was used to interpret the interviews. ResultsThe evaluation revealed that, overall, the app was regarded as very user-friendly, though some users encountered difficulties during the installation of the app and technical problems afterwards. Some patients experienced a feeling of security resulting from the symptom monitoring. Other participants did not see a personal benefit, but made suggestions for improvement in order to make the app more useful. DiscussionSymptom monitoring through the app “Nachsorge-Pass” has shown to be feasible. Potential for improvement includes the representation of the symptom course for patients, a stronger focus on psychosocial aspects, and a better integration of the app into the ongoing aftercare process. As soon as the number of users is high enough, a randomised controlled trial should be conducted in order to collect reliable evidence on the effectiveness of the app. ConclusionThe present study provides first clues about a patient-oriented design of an app for prostate cancer aftercare, which has shown a high level of user-friendliness in the first test with patients. Further development should take place in iterative cycles involving both users and health care professionals.

Complexities of Prostate Cancer.

Prostate cancer has a long disease history and a wide variety and uncertainty in individual patients' clinical progress. In recent years, we have seen a revolutionary advance in both prostate cancer patient care and in the research field. The power of deep sequencing has provided cistromic and transcriptomic knowledge of prostate cancer that has not discovered before. Our understanding of prostate cancer biology, from bedside and molecular imaging techniques, has also been greatly advanced. It is important that our current theragnostic schemes, including our diagnostic modalities, therapeutic responses, and the drugs available to target non-AR signaling should be improved. This review article discusses the current progress in the understanding of prostate cancer biology and the recent advances in diagnostic and therapeutic strategies.

On an Affordable Approach towards the Diagnosis and Care for Prostate Cancer Patients Using Urine, FTIR and Prediction Machines.

Prostate cancer is a widespread form of cancer that affects patients globally and is challenging to diagnose, especially in its early stages. The common means of diagnosing cancer involve mostly invasive methods, such as the use of patient’s blood as well as digital biopsies, which are relatively expensive and require a considerable amount of expertise. Studies have shown that various cancer biomarkers can be present in urine samples from patients who have prostate cancers; this paper aimed to leverage this information and investigate this further by using urine samples from a group of patients alongside FTIR analysis for the prediction of prostate cancer. This investigation was carried out using three sets of data where all spectra were preprocessed with the linear series decomposition learner (LSDL) and post-processed using signal processing methods alongside a contrast across nine machine-learning models, the results of which showcased that the proposed modeling approach carries potential to be used for clinical prediction of prostate cancer. This would allow for a much more affordable and high-throughput means for active prediction and associated care for patients with prostate cancer. Further investigations on the prediction of cancer stage (i.e., early or late stage) were carried out, where high prediction accuracy was obtained across the various metrics that were investigated, further showing the promise and capability of urine sample analysis alongside the proposed and presented modeling approaches.

Overcoming Obstacles in Liquid Biopsy Developments for Prostate Cancer.

Prostate cancer is one of the most common malignancies in men. Over time, it can metastasize and become lethal once it exhausts hormonal therapies and transitions into castration-resistant prostate cancer (CRPC). Several therapies have been recently approved for advanced prostate cancer, but identifying biomarkers for current treatments and searching for more effective treatments are urgently needed. Liquid biopsy is a powerful tool for isolating genetic material, proteins, and whole tumor cells from the blood. In recent decades, this technology has rapidly advanced, allowing for better insights into the pathogenesis and treatment response in different stages of prostate cancer. In this review, we summarize important clinical studies involving liquid biopsies in prostate cancer with a focus on advanced disease, notably regarding circulating tumor DNA, circulating tumor cells, and exosomes. We highlight the progress and the challenges that still exist for these technologies. Finally, we discuss promising avenues that will further expand the importance of liquid biopsy in the care for prostate cancer patients.

Clinical Efficacy and Psychological Impact of Omaha-Based Continuing Care for Prostate Cancer Patients.

Prostate cancer is a common malignancy elderly male urogenital system, because of the special disease position, and postoperative complications such as urinary retention, urinary incontinence, and sexual dysfunction, if not treated, can increase the patients' physical pain, anxiety, and other psychological burden; endocrine therapy after surgery can affect self-image and quality of life of patients. Omaha system was originally used for community health nurses, which contains three main contents: problem classification, nursing intervention, and outcome evaluation. The problem classification dimension includes four dimensions: environment, physiology, social psychology, and health-related behavior. The nursing intervention dimension is composed of 75 intervention objectives and four behavior types. Omaha system is a nursing intervention model based on individual psychological, physiological, educational level, and family and social background. The model has good clinical application effect. This study aimed to explore the continuous nursing intervention effect in the nursing of patients with prostate cancer and its psychological impact. A total of 96 prostate patients with cancer who were admitted to Taizhou First People's Hospital from November 2019 to May 2021 were divided into Omaha system care group and routine care group with 48 cases each by random number table method. The routine care group received routine care and discharge guidance, and the Omaha system care group on the basis of the routine care group; continuation care based on the Omaha system was implemented. The differences in mental state, life quality score, serum prostate specific antigen (PSA) level, average urine flow rate, and self-care ability score were compared between the routine care and Omaha system care group. The results showed that Omaha-based continuation care for prostate cancer is beneficial to reduce bad mood, improve patients' life quality score and self-care ability, and provide certain reference for clinical care of prostate cancer patients.

Clinical implications of homologous recombination repair mutations in prostate cancer.

Prostate cancer is a disease with significant interpatient genomics, with a proportion of patients presenting mutations in key homologous recombination repair (HRR) gene aberrations, particularly in late-stage disease. A better understanding of the genomic landscape of prostate cancer and the prognostic and predictive value of HRR mutations could lead to more precise care for prostate cancer patients. BRCA1/2 mutations are associated with a more aggressive disease course and higher risk of developing lethal prostate cancer, but also identify patients who could benefit from directed therapeutic strategies with PARP inhibitors. Other HRR mutations are also frequent but their prognostic and predictive value for prostate cancer patients is less clear. Moreover, a proportion of these mutations are associated with inherited germline defects, being relevant for the patients' risk of second malignancies but also to inform their relatives' risk of cancer through cascade testing. In this manuscript, we review current knowledge of the prognostic and predictive value for different HHR alterations across the different prostate cancer disease states. Additionally, we assess the challenges to implement genomic testing in clinical practice for prostate cancer patients.

Evaluating the contribution of virtual peer-led support to comprehensive prostate cancer (PCa ) care: The AnCan experience.

58 Background: Comprehensive care for PCa patients extends well beyond selecting therapies based on available guidelines. Patients should be supported to understand the disease, diagnostics, optimal treatment strategies, side-effects, avert morbidity and improve diet and exercise while combating stress. We present data supporting that patient participation in a video peer-led support group is integral to attaining these goals. Face-to-face peer groups are not readily accessible to many patients. AnCan has hosted virtual meeting support groups across the spectrum of malignancies and stages since 2010. We offer navigation, advocacy, and educational webinars. PCa is our cornerstone, including groups focusing on active surveillance/ high risk/recurrent/advanced disease, as well as under-60 patients. Methods: During spring 2021, a survey questionnaire focused on all disease stages was sent to 1174 men in the AnCan database; a second survey focused on active surveillance was send to 1200 active surveillance patients in the AnCan, Active Surveillance Patients International and Prostate Cancer International databases. We evaluated patient experience and how information acquired informed their treatment, interactions with their medical team, lifestyle, stress, and quality of life (QoL). Results: 238 responses were received for the AnCan survey, and 165 for the active aurveillance Survey, totaling. 389 independent responses. 228 (33%) were on Active Surveillance for low risk, and 93 (23%) had advanced PCa, largely distributed across North America. 154 (40%) repeatedly attend AnCan meetings. All (100%) indicated that meetings helped understand disease, navigate their treatment options, improve interaction with their medical teams and improve their quality of life (QoL). In the AnCan Suvey, 48 (19%) patients opted to move to different care teams and 32 (13 %) of those elected PCa specialists. 138 (58%) improved exercise, 90 (38%) improved diet, and 119 (50% ) reported stress reduction. 202 patients (85%) felt the groups to be welcoming, 102 (43%) connected with others, and 70 (30%) developed friendships. Of those who attend Active Surveillance meetings, 75 (68%) said that attendance helped them be their own best advocate, while 25 (23%) said that attendance informed them of new insights and treatments. Conclusions: The AnCan Support Group model increases patient knowledge, positively impacts treatment planning, and promotes lifestyle improvements while providing support to reduce stress, boosts confidence in navigating the disease, and improves QoL. AnCan empower patients to self-advocate and improve their disease experience. This is integral to optimize physician/patient interactions and improve outcomes. We advocate that virtual peer group attendance, based on our model, be included in NCCN treatment recommendations for PCa patients, especially with advanced disease.

Every urologist and oncologist should know about treating sexual and gender minority prostate cancer patients: translating research findings into clinical practice.

In 2016, the NIH designated sexual and gender minorities (SGM) a health disparity population. The next year, the American Society of Clinical Oncology highlighted the need to improve the suboptimal cancer and survivorship care received by SGM populations. There are currently no evidence-based training programs in culturally competent care of prostate cancer patients who are gay, bisexual and/or transgender. In this selective review, we summarize findings from the largest quantitative studies focused on sexual minority prostate cancer survivors and from 65 interviews with NIH staff, clinicians, and cancer clinics in 11 US cities. The report is divided into three parts and uses a question and answer format to address 21 questions relevant to clinicians providing care to SGM prostate cancer patients. First, we identify population-specific issues that are culturally relevant in the care of SGM patients with prostate cancer. While a body of research has emerged on sexual minority prostate cancer patients, the literature on gender minorities is limited to single case reports and inadequate to inform practice. This review covers definitions, population size, cultural and historical context, sexual behavior, population invisibility, sexual orientation and gender identity (SOGI) in the electronic medical record, disparities and evidence of discrimination in treatment provision. The second part focuses on promoting evidence-informed, patient-centered care. This includes current practices in assessing sexual orientation, management of disclosure of sexual orientation, how to address common problems sexual minority men experience post-treatment, common questions sexual minority patients have, management of urinary incontinence, HIV and STI risk during and post-treatment, and sub-groups of sexual minority patients with worse outcomes. It then identifies how male partners differ in prostate cancer support, current research on rehabilitation for sexual minority men, issues in advanced prostate cancer, and things to avoid with minority patients. Finally, we examine the cultural divide between provider and patient, advocating for cultural humility when working with minority patients. Training programs and continuing education can help providers both to become more aware of their own cultural assumptions, informed about health disparities, and able to provide quality care, and to make clinics more welcoming to SGM patients.

A systematic review and meta-analysis of unplanned hospital visits and re-admissions following radical prostatectomy for prostate cancer.

Unplanned visits (UPV) - re-admissions and emergency room (ER) visits - are markers of healthcare system quality. Radical prostatectomy (RP) is a commonly performed cancer procedure, where variation in UPV represents a gap in care for prostate cancer patients. Here, we systematically synthesize the rates, reasons, predictors, and interventions for UPV after RP to inform evidence-based quality improvement (QI) initiatives. A systematic review was performed for studies from 2000-2020 using keywords: "re-admission," "emergency room/department," "unplanned visit," and "prostatectomy." Studies that focused on UPV following RP and that reported rates, reasons, predictors, or interventions, were included. Data was extracted via a standardized form. Meta-analysis was completed. Sixty studies, with 406 107 RP patients, were eligible; 16 028 UPV events (approximately 5%) were analyzed from 317 050 RP patients. UPV rates after RP varied between studies (ER visit range 6-24%; re-admissions range 0-56%). The 30-day and 90-day ER visit rates were 12% and 14%, respectively; the 30-day and 90-day re-admission rates were 4% and 9%, respectively. A total of 55% of all re-admissions after RP are directly due to postoperative genitourinary (GU)-related complications, such as strictures, obstructions, fistula, bladder-related, incontinence, urine leak, renal problems, and other unspecified urinary complications. The next most common re-admission reasons were anastomosis-related, infection-related, cardiovascular/pulmonary events, and wound-related issues. Thirty-four percent of all ER visits after RP are directly due to urine-related issues, such as retention, urinoma, obstruction, leak, and catheter problems. The next most common ER visit reasons were abdominal/gastrointestinal issues, infection-related, venous thromboembolic events, and wound-related issues. Predictors for increased re-admission included: open RP, lymph node dissection, Charlson comorbidity index ≥2, low surgeon/hospital case volume, and socioeconomic determinants of health. Of the 10 interventions evaluated, a 3.4% average reduction in UPV rate was observed, highlighting an approximate two-fold decrease. Meta-analysis demonstrated a significant benefit of interventions over controls, with odds ratio 0.62 (95% confidence interval 0.46-0.84). Interventions that used multidisciplinary, nurse-centered, programs, with patient self-care/empowerment were more beneficial than algorithmic patient care pathways and preoperative patient education. Twenty years of international, retrospective experience suggests UPV after RP are often related to GU complications and infection- or wound-related factors. QI interventions to reduce UPV should target these factors. While many re-admissions after RP appear to be unavoidable, ER visits have more opportunity for volume reduction by QI. The interventions evaluated herein have the potential to reduce UPV after RP.