CaP Diagnosis Research Articles

P-2220. Real-World Utilization of a Multiplex Pneumonia PCR Panel on Antimicrobial Stewardship and Antibiotic Use

Abstract Background In October 2022 the Queen of the Valley Medical Center (QVMC) microbiology department implemented the Biofire® Pneumonia Pathogen Panel polymerase chain reaction (PCR) for identification of viral and bacterial pathogens along with resistance genes. This may aid in improved identification of pneumonia pathogens with a quicker turnaround time. In contrast, respiratory cultures take multiple days to return with both the organism and antibiotic susceptibility, which delays the time to achieving targeted therapy. Methods This was a retrospective cohort study from October 2022 to April 2023. Patients were included if they were admitted to QVMC and had a positive pneumonia PCR. Patients were excluded if they were receiving antibiotics for an indication other than pneumonia, if they did not receive antibiotics, or if they were discharged, transferred or died prior to the PCR result. The primary outcome was if the patient achieved targeted therapy. Secondary outcomes included time to targeted therapy, actions performed based on the results, and correlation between respiratory culture results and PCR. Results Fifty-nine patients were included for analysis. Most patients had a diagnosis of CAP (n = 43, 72%), vs. HAP (n = 8, 14%), and VAP (n = 8, 14%). Targeted therapy was achieved in 41 patients (70%). Seven (12%) of these patients had empiric therapy which was also targeted therapy. The mean time from PCR collection to the start of targeted therapy was 23.11 hours. For patients who had respiratory cultures collected, the mean time to final identification with susceptibilities was 40.6 hours. Therefore, targeted therapy was achieved at least 17 hours sooner than if de-escalation or escalation was solely dependent upon respiratory culture results. There were 47 antimicrobial stewardship recommendations documented, and 31 (66%) were accepted by providers. Forty-four patients (75%) also had respiratory cultures collected, and only 19 (43%) had organism growth. Conclusion Utilizing multiplex PCR technology for patients with pneumonia can be useful for antimicrobial stewardship programs by providing higher rates of pathogen identification and resistance data compared to respiratory culture alone. This allows for improved time to targeted therapy. Disclosures All Authors: No reported disclosures

P-2280. Community-Acquired Pneumonia in Immunosuppressed Patients Admitted to the ICU

Abstract Background Severe community-acquired pneumonia (sCAP) remains a crucial infectious cause of global mortality, accounting for a significant proportion of ICU admissions. Immunosuppressed patients frequently develop sCAP; however, the clinical characteristics and clinical outcomes of patients admitted to the ICU due to sCAP are not clear. Here, we attempted to bridge this gap in the literature. Figure 1 Isolated microorganisms in respiratory samples. A. General cohort; B. No immunosuppression risk factors group; C. Immunosuppression risk factors group Methods This secondary analysis of the prospective MIMIC-IV database included adults admitted to the ICU with CAP diagnosis. Patients were stratified based on the presence or absence of immunosuppression. Bivariate, multivariate, and survival analyses were conducted to identify factors associated with mortality within the immunosuppressed and their impact on hospital mortality. Figure 2 Kaplan-Meier survival curve of 1-year after discharge survival probability stratified by immunosuppression status. Patients with and without immunosuppression are represented, the first group with 1 (blue) and the last with 0 (red). Results A total of 4742 patients were included, with 1502/4742 (32%) being immunocompromised. The mean age (SD) was 66 ±16.1years, with 2627/4742 (55.4%) males. A total of 1384 respiratory isolations were obtained with Staphylococcus aureus (43.2% vs. 40.6%; p= 0.45) and Pseudomonas aeruginosa (10.20 % vs 11.69 %; p= 0.39) as the most representative in both groups (Figure 1). Immunosuppressed patients presented both higher Charlson comorbidity index (7.12, SD 3.14 vs. 4.97, SD 2.59; p < 0.01) and infection severity by the SAPS II score (39, [31-49] vs 37, [ 29-46]; p < 0.01). Immunosuppression was associated with increased mortality rates (IH: OR 1.99 [95% CI: 1.63-2.43]; 6 M: OR 1.79 [95% CI 1.52-2.12]; 12 M: OR 1.93 [95% CI 1.64-2.28]; p < 0.01) and both solid malignancy and infection severity were positively correlated with mortality (Table 1). Immunosuppressed patients had a lower survival rate even after adjusting for disease severity (Figure 2). Table 1 Univariate and multivariate analysis of risk factors associated with in-hospital, 6-month, and 12-month deaths in the immunosuppressed population. Conclusion Immunosuppression was independently associated with mortality and lower survival in sCAP patients. An individualized patient risk approach is necessary as immunosuppression affects mortality differently than immunocompetent patients. Disclosures All Authors: No reported disclosures

Diagnostic and prognostic value of heparin-binding protein in pediatric community-acquired pneumonia

BackgroundCommunity-acquired pneumonia (CAP) and its associated complications pose a noteworthy public health apprehension in the pediatric population, leading to considerable morbidity and mortality. The objective of this study was to assess the diagnostic and prognostic value of heparin-binding protein (HBP) as a promising biomarker in children hospitalized with CAP.MethodsThis prospective, single-center study included 50 children admitted to the Pediatric Pulmonology Unit between April 2023 and January 2024 with a diagnosis of CAP, as well as age-matched 50 healthy children as a control group. Demographic, clinical, and laboratory data were recorded. The measurement of serum HBP was conducted upon admission utilizing the enzyme-linked immunosorbent assay technique.ResultsSerum HBP was elevated in the CAP group in comparison to the control group (p < 0.001). Out of 50 patients, 27 (54.0%) had non-complicated pneumonia, and 23 (46.0%) had complicated pneumonia. The levels of HBP were significantly elevated in patients compared to the healthy control group and even higher in patients with complicated CAP compared to those with non-complicated CAP (p < 0.001). Analysis of the ROC curve revealed that the HBP level of ≥ 34.97 ng/ml was linked to a significantly higher AUC of 0.837 (95% CI 0.722–0.951, P < 0.001).ConclusionThe level of HBP was observed to be notably elevated in patients as compared to the healthy control, thereby indicating its potential applicability in the early detection of CAP. Moreover, elevated HBP was an independent prognostic factor for complicated CAP in children.

Mean platelet volume (MPV) and red blood cell distribution width coefficient of variation (RDW_CV) as prognostic markers in community-acquired pneumonia in children: a cross-sectional study

BackgroundCommunity-acquired pneumonia (CAP) is a major global health threat for children, causing numerous hospitalizations and deaths. CAP is a leading cause of mortality in children under five and results in millions of hospital admissions each year. Identifying reliable prognostic markers is crucial. Mean platelet volume (MPV) and red blood cell distribution width coefficient of variation (RDW_CV) are accessible and cost-effective options for prognosis assessment. This study investigates MPV and RDW_CV as prognostic markers in children with CAP.MethodsThis cross-sectional study included 150 children aged 1–15 years diagnosed with CAP upon initial examination and admitted to the hospital. CAP diagnosis was based on clinical symptoms, physical examination, and/or radiographic findings, with hospitalization criteria set for CAP in children. CAP severity was assessed using the Clinical Respiratory Score, categorizing patients into mild, moderate, and severe groups. MPV and RDW_CV were compared among these groups.ResultsAmong the patients, 71 (47.3%) were girls, and 79 (52.7%) were boys. The average hospitalization duration was 6.24 ± 3.82 days, with a median of 5 days. Disease severity distribution was 58 (38.7%) mild, 54 (36.0%) moderate, and 38 (25.3%) severe. Both RDW_CV and MPV were higher in severe cases and in children hospitalized for more than 10 days (P < 0.001). A significant positive correlation was observed between RDW_CV and MPV (r = 0.636, P < 0.001). Mean RDW and MPV values were significantly elevated in children needing ICU admission and those with pleural effusion (P < 0.001). The RDW_CV cutoff was 13.75, with 97.4% sensitivity and 80.4% specificity. The MPV cutoff was 8.25, with 78.9% sensitivity and 69.6% specificity.ConclusionElevated RDW_CV and MPV levels are associated with severe CAP in hospitalized children, providing valuable prognostic insights. RDW_CV is a more precise prognostic indicator than MPV, demonstrating superior predictive value in CAP management.

Increased plasma AACT level as an indicator of poor prognosis in patients hospitalised with community-acquired pneumonia: a multicentre prospective cohort study

Background and objectiveCommunity-acquired pneumonia (CAP) is a common respiratory disease that frequently requires hospitalisation, and is a significant cause of death worldwide. This study aimed to evaluate the usefulness of alpha-1-antichymotrypsin (AACT) as a diagnostic and prognostic biomarker of CAP.MethodsWe conducted a multicentre prospective cohort study in patients hospitalised with CAP. Plasma AACT levels were measured using a quantitative enzyme-linked immunosorbent assay. Receiver-operating characteristic (ROC) curves and Cox proportional hazards regression were used to assess the association between plasma AACT levels and CAP diagnosis and prognosis.ResultsA total of 274 patients with CAP were enrolled in the study. AACT levels were elevated in patients with CAP, especially those with severe CAP and non-survivors. The area under the curve (AUC) of AACT and CRP for diagnosing CAP was 0.755 and 0.843. Cox regression showed that CURB-65 and AACT levels were independent predictors of 30-day mortality. ROC curves showed that plasma AACT levels had the highest accuracy for predicting acute respiratory distress syndrome (ARDS), with an AUC of 0.862. Combining AACT with Pneumonia Severity Index and CURB-65 significantly improved their predictive accuracy for predicting 30-day mortality.ConclusionPlasma AACT levels are elevated in patients with CAP, but plasma AACT level is inferior to the C-reactive protein level for diagnosing CAP. The AACT level can reliably predict the occurrence of ARDS and 30-day mortality in patients with CAP.

A Scoping Review of Stigma Related to Prostate Cancer in Black Men.

Prostate cancer (CaP) disproportionately affects 1-in-4 Black men and is a stigmatised disease within their communities. Yet, Black men are underrepresented in CaP research concerning stigma, which necessitates a scoping review to map available evidence on this topic to inform future research. To map published literature on stigma related to CaP in Black men to understand their experiences and/or perceptions and identify directions for future research. A scoping review was conducted using the five-step framework by Arksey and O'Malley. Studies published in English addressing stigma related to CaP from the perspectives of Black men and/or their families were included. We searched six databases including Medline, Embase, PsycInfo, CINAHL, Web of Science Core Collection and Google Scholar, from inception to April 2023. Citation searches were also conducted. Two independent reviewers conducted screening and data extraction. Data was synthesised using descriptive content analysis. Thirty-four eligible studies conducted in the USA, UK, Trinidad and Tobago, South Africa, Cameroon and Canada from 1995 to 2023 were included. A total of 1867 Black men with/without a CaP diagnosis and 145 adult partners were included. Review findings showed a complex intersection of self-stigma, public stigma and structural stigma impacted Black men's perceptions of their masculinity. While men's experiences/perceptions of stigma varied depending on their illness status, there were commonalities in their masculinity concerns (underpinned by stigma), which influenced their attitude towards digital rectal examination, post-treatment side effects and social interactions on CaP. These have implications for public health messaging on CaP within Black communities, as well as patient-provider interactions with the men. This novel review highlights the need to pay attention to how CaP is presented to Black men and their communities using avenues and languages that are culturally acceptable and empower them to negotiate self-stigma, public stigma and structural stigma related to CaP. Directions for further research were also identified.

PET-CT 18F-PSMA 1007 in the staging of patients with prostate cancer prior to curative intent radiotherapy: a prospective observational study

Objective: The objective of our study was to assess whether there are staging changes in CaP with PET PSMA compared to standard diagnostic methods, and if these changes occurred, to understand how they altered the treatment of patients with an initial diagnosis of CaP and their relationship with the D'amico score. Methods: We present a prospective observational study conducted on patients initially diagnosed with prostate cancer, who underwent standard staging studies alongside PET PSMA imaging. Results: Forty patients diagnosed with prostate cancer were staged using standard diagnostic methods and PET PSMA. In 40% of the patients, initial staging changed based on the results obtained from PET PSMA. After PET PSMA, the uro-oncology committee decided to modify the initial treatment plan in 27.5% of the cases, including radiation boost targeting the extra-prostatic lesions detected by PET PSMA. When correlating the change in staging with PET PSMA versus the D'amico risk score, no changes were observed in the low-risk group, 19% in the intermediate-risk group, and 62% in the high-risk group. These differences were statistically significant (X2=9.2; df=2; p=0.01). Limitation and value: The study faced limitations in sample size and lack of long-term patient follow-up. However, it highlights key contributions: the promising evaluation of PET PSMA in staging, its influence on therapeutic decisions, and its association with the D'amico score. Conclusion: PET PSMA showed substantial changes in CaP staging, particularly in higher-risk patients, suggesting its potential utility in guiding therapeutic decisions before radiotherapy.

Assessing the diagnostic impact of P63, PSA and BCL-2 proteins in premalignant and malignant prostate tissues

Background: Prostate cancer (CaP) is increasingly becoming a major health issue affecting men as cancer-related fatalities are attributable to the condition. Immunohistochemistry (IHC) diagnostic criteria can help in gene-targeted therapy and help reduce its prevalence. This study is to assess the diagnostic impact of prostate-specific antigen (PSA), P63 and BCL-2 antibodies in CaP. Method: A case-controlled retrospective study was carried out on eighty (80) prostrate tissue blocks retrieved from the pathology archive of Ekiti State university teaching hospital Ado Ekiti. IHC analysis of the selected antibodies was carried out and also stained with haematoxylin and eosin (H and E) for second opinion and confirmation. Results: The study showed that all the CaP samples had 100% positivity with varying reactivity to the IHC biomarkers; PSA had 100% positivity and MPR of 94% due to its multiple weaknesses as a biomarker p63 is a basal cells marker. Conclusions: The expressions of these antibodies were observed in the progression of CaP. Although these markers are useful in predicting the progression from benign prostatic hyperplasia (BPH) to CaP, none of them can be utilised in isolation to a conclusion. Hence, they should be used in conjunction with one another to make up for their limitations. The immunohistochemical markers are beneficial in CaP diagnosis.

(117) PROSTATE CANCER SCREENING IN TRANSGENDER WOMEN: A SCOPING REVIEW

Abstract Introduction Prostate cancer screening in transgender women is an emerging and underexplored topic in medical literature. With increased visibility and recognition of the specific health needs of this population, understanding the risks and challenges associated with prostate cancer in transgender women is crucial. The prostate, which remains intact during gender-affirming surgery, can develop malignancies, needing appropriate screening protocols. This scoping review aims to consolidate existing evidence on the incidence, clinical characteristics, and management of prostate cancer in transgender women, identify barriers to screening, and propose recommendations for improving early detection and oncological care. Objective This scoping review aims to map existing literature on prostate cancer screening in transgender women, evaluating current practices, efficacy, barriers, and facilitators. Methods The methodology for this scoping review followed the PRISMA model, encompassing identification, screening, eligibility, and inclusion stages. Searches were conducted in the MEDLINE, Biblioteca Virtual em Saúde (BVS), and LIVIVO databases using the search strategy: (prostate cancer) AND (transgender persons OR transgender women) AND (screening). Without a specified time frame, 63 articles were initially found. After removing 24 duplicates, 39 articles remained. Of these, 22 were excluded: 8 did not address prostate cancer, 8 did not discuss screening, 4 were inaccessible, and 1 did not focus on transgender women. Results The literature on prostate cancer (CaP) in transgender women (TGW) reveals a low but significant incidence. One study identified 10 cases, highlighting the need for screening similar to that for cisgender men, as estrogen therapy may not be protective. Another study reported a median incidence of CaP in TGW of 44.1 cases per 100 000 person-years, with a higher mortality risk post-diagnosis. The reduced incidence might be due to the atrophying effect of estrogen on the prostate. Gender-affirming hormone therapy (GAHT) induces histological changes in both benign and malignant prostate tissues, complicating cancer evaluation. CaP management in TGW should be individualized, considering the patient’s hormonal and surgical history. PSA screening rates in TGW are lower than in cisgender men, even after adjusting for medical visits, suggesting the influence of hormone therapy duration and type. Awareness of CaP risk is crucial for TGW post-gender-affirming surgery, underscoring the need for better information and communication from surgeons. The lack of specific screening guidelines and the importance of holistic management were highlighted to mitigate the impact on quality of life. Hormone therapy might have a protective effect in reducing CaP incidence in TGW aged 50 to 64. However, there is no consensus on PSA screening in TGW, indicating a need for clinical guidelines to improve healthcare for this population. Conclusions These results underscore the urgent need for longitudinal studies and specific guidelines to optimize the diagnosis and treatment of CaP in TGW. Future studies should focus on establishing appropriate baseline PSA values, determining the right timing to initiate screening, and improving biomarker accuracy in TGW undergoing hormone therapy. Additionally, healthcare professionals must be well-informed and trained to meet the specific needs of this population, considering both medical and psychosocial aspects of CaP management in TGW. Disclosure No.

Sensitivity and Specificity of Digital Rectal Examination for the Diagnosis of Prostate Cancer at the Kano Teaching Hospital - A Comparative Analysis

Background: Prostate cancer (CaP) is the most common non-cutaneous cancer among males and the fourth most common cause of cancer in males globally. Unfortunately, Sub-Saharan Africa lacks the relevant resources and organized screening program that has led to the late presentations in the region. Digital rectal examination (DRE) is a test commonly used to screen for prostate carcinoma and is by far the oldest and cheapest modality available for screening. Objective: We hypothesized that digital rectal examination has a correlation to the diagnosis of prostate cancer. This study was meant to evaluate the sensitivity and specificity of DRE in the diagnosis of prostate cancer and compare the outcome to published data. Methodology: This is a prospective study conducted at the Aminu Kano Teaching Hospital involving 87 symptomatic patients who were screened for prostate cancer (2014). Patient with DRE suspicious of malignancy i.e. (nodular, hard, asymmetrical prostate) or PSA &gt;4ng/ml despite the prostate consistency were included in the study. The digital rectal exams were performed in a lateral decubital position to assess the prostate consistency and underwent transrectal ultrasound guided sextant biopsy for histological diagnosis. Results: There was a total of 87 participants that underwent DRE in the study with age range from 50 – 96 years. Univariate analysis showed a mean age of 68.1 years with standard deviation of (SD +9.4). The detection rate of prostate cancer was 28.7%. Bivariate analysis of DRE to diagnosis of prostate cancer showed a sensitivity of 68.0% and specificity of 83.9%. The positive predictive value and the negative predictive value were 63.0% and 86.7% respectively. The study showed some evidence of a relationship between DRE and the diagnosis of prostate cancer with a (Pearson Chi Square Test=23.4, df=1,) with a statistical significance (p=&lt;0.001). Conclusion: PSA and Digital rectal exam combined have a higher sensitivity in the diagnosis of prostate cancer. However, DRE alone has a lower sensitivity but a much higher specificity in the diagnosis of CaP. DRE still has a role in the diagnosis of CaP because it is minimally invasive, cheaper and can detect some prostate cancers that are missed by PSA screening.

Abstract 1013: Strengths, weaknesses, opportunities, and threats of conducting clinical trials in Nigeria: The IRONMAN study

Abstract Background: The need to increase understanding of prostate cancer (CaP) is ever increasing. Unfortunately, there is limited understanding of how CaP affects men of African ancestry (MAA) despite significant disparities in CaP prevention, diagnosis, and treatment due to genetic and sociobehavioral factors. Conducting CaP clinical trials (CTs) in Africa presents multiple opportunities to improve upon collective knowledge of CaP in MAA experiences, expand patient access to CTs, and provide opportunities for African scientists and urologists to contribute to research on the global stage. The International Registry of Men with Advanced Prostate Cancer (IRONMAN) seeks to reduce CaP disparities by sponsoring sites throughout Africa. Four Prostate Cancer Transatlantic Consortium (CaPTC) institutions in Nigeria currently participate in IRONMAN: University of Ilorin Teaching Hospital, Federal Medical Center, University of Maiduguri, and Lagos State University Teaching Hospital. Because CTs of this scale are infrequently conducted in Africa, there are special considerations when conducting CTs in low-middle-income countries (LMICs) like Nigeria. Methods: Hourlong interviews dedicated to site staff were conducted via Zoom in Spring 2023 (four total). Interviews utilized a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis approach. Each interview was recorded, transcribed, and validated by study staff for accuracy. Themes from each were inductively coded and then collated across all four sites. Results: The urologists, oncologists, phlebotomists, pathologists, nurses, research coordinators that make up the study teams identified the holistics of conducting the IRONMAN study at their sites. Strengths included a large patient population to recruit from and appropriate resources to conduct the study (ex., lab space, clinical knowledge, staffing levels). Weaknesses included the social determinants of health that negatively impact patient participation, limited biorepository space to store samples, and the need for patient-physician trust. The greatest opportunity presented was Nigerian institutions joining more CTs in the future, particularly multi-site global trials. Described threats included staff turnover, national stability, and increased economic disparities. Discussion: While increasing the overall number of CTs in Africa is a noble cause, sponsors and institutions should note the unique circumstances in implementing CTs in Africa when designing CTs and recruiting sites. Listening to the experiences of study teams is pivotal in ensuring CTs are Africa-minded - they will be complimentary to established research infrastructure, appropriately funded, and culturally responsive all in the name of equitable research. By doing so, ethical compliance and quality data collection will ensue and reduce disparities at the micro, mezzo, and macro levels. Citation Format: Opeyemi Oreoluwa Bolajoko, Parisa Fathi, Oluwaseyi Toye, Dottington D. Fulwood, Ademola Popoola, Chidiebere Ogo, Hassan Dogo, Omolara Fatiregun, Anthonia Sowumi, Paul Jibrin, Mutiu A. Jimoh, Faruk Mohammed, Folakemi Odedina, Prostate Cancer Transatlantic Consortium. Strengths, weaknesses, opportunities, and threats of conducting clinical trials in Nigeria: The IRONMAN study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1013.

Bacterial Community- and Hospital-Acquired Pneumonia in Patients with Critical COVID-19-A Prospective Monocentric Cohort Study.

The impact of bacterial pneumonia on patients with COVID-19 infection remains unclear. This prospective observational monocentric cohort study aims to determine the incidence of bacterial community- and hospital-acquired pneumonia (CAP and HAP) and its effect on mortality in critically ill COVID-19 patients admitted to the intensive care unit (ICU) at University Hospital Olomouc between 1 November 2020 and 31 December 2022. The secondary objectives of this study include identifying the bacterial etiology of CAP and HAP and exploring the capabilities of diagnostic tools, with a focus on inflammatory biomarkers. Data were collected from the electronic information hospital system, encompassing biomarkers, microbiological findings, and daily visit records, and subsequently evaluated by ICU physicians and clinical microbiologists. Out of 171 patients suffering from critical COVID-19, 46 (27%) had CAP, while 78 (46%) developed HAP. Critically ill COVID-19 patients who experienced bacterial CAP and HAP exhibited higher mortality compared to COVID-19 patients without any bacterial infection, with rates of 38% and 56% versus 11%, respectively. In CAP, the most frequent causative agents were chlamydophila and mycoplasma; Enterobacterales, which were multidrug-resistant in 71% of cases; Gram-negative non-fermenting rods; and Staphylococcus aureus. Notably, no strains of Streptococcus pneumoniae were detected, and only a single strain each of Haemophilus influenzae and Moraxella catarrhalis was isolated. The most frequent etiologic agents causing HAP were Enterobacterales and Gram-negative non-fermenting rods. Based on the presented results, commonly used biochemical markers demonstrated poor predictive and diagnostic accuracy. To confirm the diagnosis of bacterial CAP in our patient cohort, it was necessary to assess the initial values of inflammatory markers (particularly procalcitonin), consider clinical signs indicative of bacterial infection, and/or rely on positive microbiological findings. For HAP diagnostics, it was appropriate to conduct regular detailed clinical examinations (with a focus on evaluating respiratory functions) and closely monitor the dynamics of inflammatory markers (preferably Interleukin-6).

Prostate cancer diagnosed and staged using UV-irradiated urine samples and a paper-based analytical device

The early detection of prostate cancer (CaP), one of the most common cancers in males, improves treatment efficacy. However, current methods to detect CaP are limited by specificity and sensitivity or require an invasive and unpleasant procedure. Therefore, there is a need for a novel, fast, and noninvasive CaP detection method. This proof-of-concept study aimed to diagnose CaP from urine samples by detecting the UV-induced fluorescent clusters formed in situ that reflect a urine composition specific to CaP patients using fluorescence spectroscopy. The UV-induced clusters formed upon irradiation by UV light with a wavelength of 254 nm were detected at excitation and emission wavelengths of 400 nm and 460 nm. Fifteen patients with CaP were correctly distinguished from 5 controls. The different stages of CaP could be further determined using molecular imprinting technology. Additionally, a paper-based analytical device was developed that enabled the correct identification of stage I cancer patients by fluorescent spectroscopy detection and the naked eye. In conclusion, this novel, easy-to-operate, point-of-care assay can enable early diagnosis of CaP with high accuracy and judgement of the disease stage. The simplicity, as well as versatility of the proposed method, will enable its application also to other diseases and disorders.

Abstract C013: Importance of statistical considerations in multi-center, transatlantic cancer disparity studies: Lessons learned from the CaPTC prostate cancer familial cohort study

Abstract The CaPTC prostate cancer (CaP) Familial Cohort study (CaPFCS) was launched in 2017 to explore the CaP risk factors of African Black men (ABM). The study design is a prospective study that observes and follows healthy ABM and ABM diagnosed with CaP. Aim: The specific aim is to provide recommendations on statistical considerations for cohort studies focused on cancer disparities, based on lessons learned from the CaPTC CaPFCS. Methodology: Study participants were ABM in Cameroon, Nigeria, and the US. Using validated measures, data were collected mostly by self-administered or research assistant administered survey using paper survey (especially in Cameroon and Nigeria) with the responses transferred to REDCap by research coordinators. The statistical analysis for the CaPTC CaPFCS focused on the baseline epidemiological, behavioral, clinical and anthropometric measures of Black men. A total of 819 participants were included in the analyses. Statistical analyses included descriptive statistics (sample median, range, frequency and percentages) and unadjusted logistic regression models. Results: Data collection for the CaPTC CaPFCS were by multiple investigators/research coordinators at multiple sites in Cameroon, Nigeria, and the US. In preparation for the data analyses, we noted data entry errors and/or misinterpretation of data entry, which required extensive cleaning of the database prior to the analyses. The biostatisticians spent significant effort cleaning and ensuring data validity prior to the analyses. Confounding variables is another statistical consideration for cohort studies, such as the CaPTC CaPFCS. There was variability observed across age, education levels, employment status, household income and CaP diagnosis based on country of residence. CaP diagnosis was not reported by any of the ABM in the US, which may be due to the fact that they were all recruited within the community and no recruitment took place in the clinic. Finally, the CaPTC CaPFCS has several variables. Performing a lot of statistical tests may result in false-positive findings at P&amp;lt;0.05.Conclusion: The advantage of the CaPFCS is that it allows the CaPTC investigators to study epidemiological, behavioral, clinical and anthropometric variables associated with CaP over time. Being a longitudinal cohort study, investigators can track the changes in exposure and outcomes over time.However, statistical considerations need to be at the fore-front of multi-center, transatlantic cancer disparity studies such as the CaPTC CaPFCS, from data collection to data entry. The use of web-based survey with the ability to enter data directly into REDCaP will significantly reduce (if not totally eliminate) the need for database cleaning. There are multiple strategies that can be used to reduce confounder effect, including statistical adjustment and multivariate analysis to adjust for the confounders. The use of propensity score methods have especially been found to be effective in controlling baseline confounding factors. Citation Format: Daniel Lee, CaPTC Investigators, Jennifer Crook, Ruth Enuka, Fathi Parisa, Emeka Iweala Iweala, Oluwole Kukoyi, Ernest Kaninjing, Oluwaseyi Toye, Paul Jibrin, Folakemi Odedina. Importance of statistical considerations in multi-center, transatlantic cancer disparity studies: Lessons learned from the CaPTC prostate cancer familial cohort study [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C013.

P09 A catastrophic decline: a significant skin rash in a patient presenting with catastrophic antiphospholipid syndrome

P09 A catastrophic decline: a significant skin rash in a patient presenting with catastrophic antiphospholipid syndrome

Abstract IA007: Science of prostate cancer care and survivorship in black men: Structural, social and biological determinants

Abstract Black men are disproportionately affected by prostate cancer (CaP), with limited progress in closing the CaP care and survivorship gaps experienced by Black men compared to other racial/ethnic groups. Unfortunately, there is an uptick in CaP incidence rate in the United States (US) since 2014. As reported by the American Cancer Society, the rising CaP incidence rate indicates a shift towards higher grade and stage during diagnosis. The prostate cancer (CaP) disparities experienced by Black men in the US is a microcosm of the global burden of CaP seen in men of African ancestry. For example, the top ten countries leading CaP mortality in the world are all Black nations in Africa and the Caribbean. The complexity of CaP disparities and the need for a unique approach to better understand and address a complex chronic disease, such as CaP, underscores the need for consortium research that is multilevel, collaborative, translational, and global. Through the Department of Defense funding, we formed an inclusive Cancer Care Research Equity (iCCaRE) for Black Men Consortium to advance health equity and reduce disparities in CaP. Comprising CaP survivors, advocates, scientists, and clinicians, the iCCaRE for Black Men Consortium addresses structural, social and biological determinants of CaP among ethnically diverse Black men globally, including US Black men, West African immigrant men in the US and indigenous West African men. The overall goal of the iCCaRE consortium is to optimize CaP diagnosis experiences, treatment and survivorship based on the Science of Survivorship (SOS). Our central hypothesis is that improving social-determinants of health (SDOH) factors, CaP care and survivorship (CaPCaS)-related factors and mediating biological factors will lead to an improvement in patient-reported outcomes (PROs). This presentation will highlight the structural inequities, societal injustices and biological determinants found to be associated with CaP care and survivorship among Black men. Additionally, we will present the use of Community Living Lab (CoLLab) Health System approach to address inequity in minoritized and marginalized communities. Citation Format: Folakemi Odedina, Roxana Dronca, Kimlin Ashing, Ernest Kaninjing, Solomon Rotimi, Che Ngufor, Arnold Merriweather, iCCaRE Consortium. Science of prostate cancer care and survivorship in black men: Structural, social and biological determinants [abstract]. In: Proceedings of the AACR Special Conference: Advances in Prostate Cancer Research; 2023 Mar 15-18; Denver, Colorado. Philadelphia (PA): AACR; Cancer Res 2023;83(11 Suppl):Abstract nr IA007.

PD20-04 TRENDS IN PROSTATE CANCER DIAGNOSIS IN TRANSGENDER WOMEN: A NATIONAL STUDY

You have accessJournal of UrologyCME1 Apr 2023PD20-04 TRENDS IN PROSTATE CANCER DIAGNOSIS IN TRANSGENDER WOMEN: A NATIONAL STUDY Farnoosh Nik-Ahd, Amanda De Hoedt, Christi Butler, Jennifer T. Anger, Peter R. Carroll, Matthew R. Cooperberg, and Stephen J. Freedland Farnoosh Nik-AhdFarnoosh Nik-Ahd More articles by this author , Amanda De HoedtAmanda De Hoedt More articles by this author , Christi ButlerChristi Butler More articles by this author , Jennifer T. AngerJennifer T. Anger More articles by this author , Peter R. CarrollPeter R. Carroll More articles by this author , Matthew R. CooperbergMatthew R. Cooperberg More articles by this author , and Stephen J. FreedlandStephen J. Freedland More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003286.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Little is known about prostate cancer (CaP) screening and diagnosis in transgender women (TW). To date, only 10 case reports have been published on CaP in this population. In this study, we sought to understand the clinical characteristics and CaP screening history at prostate cancer diagnosis among TW. METHODS: This is a retrospective study of all patients ages 18 and older across the entire Veterans Affairs Health System (VAHS) in the United States from January 2000-February 2022 with both an ICD code for CaP and at least one ICD code related to transgender identity. Detailed chart review was performed to stratify patients by gender-affirming hormone usage. Data abstracted included PSA at diagnosis, consistency of PSA screening, clinical stage, bilateral orchiectomy status, biopsy grade group, and primary treatment modality. Consistent PSA screening was defined as screening at least every 2 years between ages 55-69, as per American Urological Association screening guidelines. RESULTS: After detailed chart review, 133 TW with CaP were identified. After stratification by use of estrogen for gender-affirming hormone therapy, 99 had no prior estrogen use, 15 were formerly on estrogen but had stopped prior to diagnosis, and 19 were actively on estrogen at diagnosis. Only 25-33% of TW were undergoing consistent guideline-based PSA screening regardless of estrogen usage. Median duration of estrogen use was 44 months and 11 months, respectively, for those formerly on estrogen and those actively on estrogen at diagnosis. Among all patients, PSA, PSA density, and grade group were highest among those on estrogen at diagnosis followed by those formerly on estrogen. CONCLUSIONS: This is the largest study of CaP in TW to date. Nonetheless, our study population of 133 CaP patients was much lower than expected given the estimated TW population within the VAHS. The degree to which this represents the effects of estrogen therapy on CaP diagnosis and/or dramatic underdiagnosis due to limited guideline-based PSA screening even among those with CaP requires further study. Future work should aim to understand the incidence and long-term outcomes of CaP in this population and establish guidelines for CaP screening for those on gender-affirming hormone therapy. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e584 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Farnoosh Nik-Ahd More articles by this author Amanda De Hoedt More articles by this author Christi Butler More articles by this author Jennifer T. Anger More articles by this author Peter R. Carroll More articles by this author Matthew R. Cooperberg More articles by this author Stephen J. Freedland More articles by this author Expand All Advertisement PDF downloadLoading ...

Adherence to use of blood cultures according to current national guidelines and their impact in patients with community acquired pneumonia: A retrospective cohort

BackgroundCommunity acquired pneumonia (CAP) is the most frequent cause of mortality secondary to infectious etiologies. Recommendations about the use of blood cultures in the diagnosis and treatment of CAP has been a contentious topic of debate and ever-changing recommendations. MethodsA cohort study was conducted in a community teaching hospital. All the patients that were admitted with a diagnosis of CAP, between January and December of 2019 were included. Sociodemographic and clinical characteristics were obtained. Blood cultures results were obtained, and it was evaluated if they were done in compliance with current recommendations by the Infectious Disease Society of America (IDSA). Results721 patients were included in the study. Median age was 68 years and 50% of the patients were male (n = 293). Patients presented from home (84%) and the most common comorbidities were hypertension and diabetes (68% and 31%). 96 patients had positive blood culture and 34% (n = 247) of all the blood cultures were adequately ordered. 80 patients died or went to hospice and the median length of hospital stay in our cohort was 7 days. The multivariate model showed that mortality was associated with positive blood cultures (OR = 3.1 95%CI 1.63–5.87) and appropriateness of blood cultures (OR = 2.96 95% CI 1.2–5.7). ConclusionAdequate use of blood cultures in patients with CAP might have some association with the outcomes of this disease. However, a prospective study evaluating the utility of this test following current IDSA recommendations is needed to understand their impact in mortality and morbidity.

Serum-integrated omics reveal the host response landscape for severe pediatric community-acquired pneumonia

ObjectiveCommunity-acquired pneumonia (CAP) is the primary cause of death for children under five years of age globally. Hence, it is essential to investigate new early biomarkers and potential mechanisms involved in disease severity.MethodsProteomics combined with metabolomics was performed to identify biomarkers suitable for early diagnosis of severe CAP. In the training cohort, proteomics and metabolomics were performed on serum samples obtained from 20 severe CAPs (S-CAPs), 15 non-severe CAPs (NS-CAPs) and 15 healthy controls (CONs). In the verification cohort, selected biomarkers and their combinations were validated using ELISA and metabolomics in an independent cohort of 129 subjects. Finally, a combined proteomics and metabolomics analysis was performed to understand the major pathological features and reasons for severity of CAP.ResultsThe proteomic and metabolic signature was markedly different between S-CAPs, NS-CAPs and CONs. A new serum biomarker panel including 2 proteins [C-reactive protein (CRP), lipopolysaccharide (LBP)] and 3 metabolites [Fasciculol C, PE (14:0/16:1(19Z)), PS (20:0/22:6(4Z, 7Z, 10Z, 13Z, 16Z, 19Z))] was developed to identify CAP and to distinguish severe pneumonia. Pathway analysis of changes revealed activation of the cell death pathway, a dysregulated complement system, coagulation cascade and platelet function, and the inflammatory responses as contributors to tissue damage in children with CAP. Additionally, activation of glycolysis and higher levels of nucleotides led to imbalanced deoxyribonucleotide pools contributing to the development of severe CAP. Finally, dysregulated lipid metabolism was also identified as a potential pathological mechanism for severe progression of CAP.ConclusionThe integrated analysis of the proteome and metabolome might open up new ways in diagnosing and uncovering the complexity of severity of CAP.

Natural History of Patients with Prostate MRI Likert 1-3 and Development of RosCaP: a Multivariate Risk Score for Clinically Significant Cancer.

Clinically significant prostate cancer (csCaP) with Gleason ≥3+4 is found in 10% negative prebiopsy multiparametric (mp) MRI cases and varies widely for equivocal mpMRI cases. The objective of this study was to investigate long-term outcomes of patients with negative and equivocal mpMRIs and to develop a predictive score for csCaP risk stratification in this group. Patients who underwent an upfront mpMRI between May 2015 and March 2018 with an MRI score Likert 1 to 3 were included in the study. Patients had either a CaP diagnosis at MRI-targeted biopsy or were not diagnosed and attended follow-up in the community. Outcomes were analysed through the Kaplan-Meier estimator and Cox Model. Regression coefficients of significant variables were used to develop a Risk of significant Cancer of the Prostate score (RosCaP). At first assessment 281/469 patients had mpMRI only and 188/469 mpMRI and biopsy, 26 csCaP were found at biopsy, including 10/26 in Likert 3 patients. 12/371 patients discharged without CaP after first assessment were diagnosed with csCaP during a median of 34.2 months' follow-up, 11/12 diagnosis occurred in patients omitting initial biopsy. csCaP diagnosis-free survival was 95.7% in the MRI group and 99.1% in the biopsy group. From these outcomes, a continuous RosCaP score was developed: RosCaP=0.083 x Age - 0.202 x (1/PSA Density)+0.786 (if Likert 3), and 4 risk classes were proposed. Limitations include retrospective design and absence of external validation. Age, PSA Density and MRI Likert score were significantly associated to the risk of csCaP and utilised to devise the novel RosCap predictive score focused to support risk assessment in patients with negative or equivocal mpMRI results.