Genitourinary Oncology Research Articles

Plant-based diets and urological health.

Plant-based diets have grown in popularity owing to multiple health and environmental benefits. Some evidence suggests that plant-based diets are associated with benefits for urological health. In genitourinary oncology, most research has focused on prostate cancer. Clinical trial results suggest a favourable influence of healthy lifestyle modifications including plant-based diets before and after prostate cancer treatment. Epidemiological evidence shows that a diet higher in plant-based and lower in animal-based food is associated with a lower risk of aggressive prostate cancer and better quality-of-life scores than a diet with less plant-based and more animal-based food. Studies on bladder and kidney cancer are scarce, but limited data suggest that vegetarian or plant-forward dietary patterns (increased consumption of fruits and vegetables and minimizing meat) are associated with a lower risk of development of these cancers than dietary patterns with fewer fruits and vegetables and more meat. With respect to benign urological conditions, epidemiological studies suggest that plant-based dietary patterns are associated with a lower risk of benign prostatic hyperplasia and urinary tract infections than non-plant-based dietary patterns. Compared with diets high in animal-based foods and low in plant-based foods, a substantial body of epidemiological evidence also suggests that increased consumption of healthy plant-based food is associated with a lower risk of erectile dysfunction. Plant-based dietary patterns that are high in fruits and vegetables with normal calcium intake, while limiting animal protein and salt, are associated with a lower risk of kidney stone development than dietary patterns that do not follow these parameters. Overall, increasing consumption of plant-based foods and reducing intake of animal-based foods has favourable associations with multiple urological conditions.

CACA guidelines for holistic integrative management of prostate cancer

Prostate cancer (PC) is an epithelial malignancy occurring in the prostate. PC ranks second in incidence among all male malignancies globally by the latest statistics from the World Health Organization. Notably, China has seen a more rapid increase in PC incidence compared to developed European and American nations. By 2022, the newly reported cases and deaths due to PC in China increased to 134,200 and 47,500, respectively. Thus, early diagnosis and standardized treatment for prostate cancer in China remain far-reaching objectives. Burgeoning research on advanced PC and castration-resistant prostate cancer in recent years have paved the way for a new era of integrated treatment methods including novel endocrine drugs, chemotherapy, targeted therapy, and immunotherapy. Future therapies involve precision treatment guided by genetic testing and individualized integrated treatment as part of a multidisciplinary integrated diagnosis and treatment model for PC. The Genitourinary Oncology Committee of the China Anti-Cancer Association (CACA-GU) has invited multidisciplinary experts across fields including surgery, oncology, pathology, radiology, herbal medicine, physiatry, and psychology to collaboratively write, discuss, and revise guidelines on managing PC. The CACA Guidelines for Holistic Integrative Management of Prostate Cancer includes epidemiology, screening and diagnosis, treatment for localized PC, diagnosis and treatment of PC recurrence after radical prostatectomy, management of metastatic PC, traditional Chinese medicine diagnosis and treatment of PC, and rehabilitation from PC. This guideline aims to standardize the clinical diagnosis and treatment management of PC in China. It is more aligned with China’s clinical practice, highlights Chinese characteristics, and bears significant clinical importance.

Factors Guiding Clinical Decision-Making in Genitourinary Oncology.

Clinical decision-making in oncology is a complex process, with the primary goal of identifying the most effective treatment tailored to individual cancer patients. Many factors influence the treatment decision: disease- and patient-specific criteria, the increasingly complex treatment landscape, market authorization and drug availability, financial aspects, and personal treatment expertise. In the domain of genitourinary cancers, particularly prostate cancer, decision-making is challenging. Despite the prevalence of this malignancy, there are few in-depth explorations of these factors within real-world scenarios. Understanding and refining this intricate decision-making process is essential for future successful clinical decisions and the integration of computerized decision support into clinicians' workflows. The objective of this study is to improve the current knowledge base and evidence of the factors that influence treatment decision-making for patients with genitourinary cancers. Assessment of how routine treatment decisions are made for genitourinary cancers was performed by a mixed-methods study, encompassing field observations and focus group discussions. In total, we identified 59 factors that influence clinical decision-making in oncology, specifically for genitourinary and prostate cancer. Of these, 23 criteria can be classified as decision-maker-related criteria encompassing personal, cognitive, and emotional attributes and factors of both, healthcare professionals and patients. Moreover, 20 decision-specific criteria have been identified that refer to clinical and disease-related factors, followed by 16 contextual decision factors that describe the relevant criteria introduced by the specific circumstances and environment in which the treatment decision is made. By presenting an exhaustive set of decision factors and providing specific examples for genitourinary cancers, this observational study establishes a possible framework for a better understanding of decision-making. Moreover, we specify and expand the set of decision factors, while emphasizing the importance of cognitive, emotional, and human factors, as well as the quality and accessibility of decision-relevant information.

PSA Levels and Mortality in Prostate Cancer Patients

IntroductionProstate cancer (PC) is the second most common cancer among men around the world. Several smaller studies have explored the relationship between elevated PSA and mortality, but results have been conflicting. Additionally, studies have shown that Black men are more likely to be diagnosed with PC at late-stages and may have a twofold increase in mortality risk. This study aims to evaluate the relationship between PSA levels and mortality in patients with PC and differences between Black versus White patients. MethodsIn this retrospective study, the TriNetX database, was used to extract de-identified EMRs of 198,083 patients. Patients were included if they were diagnosed with PC and had obtained a PSA level (measured in ng/mL) within 6 months prior to diagnosis. Cohorts were separated into 7 groups based on intervals of PSA, ranging from < 2 to ≥ 500 and compared to a control cohort with a PSA of 4 to 20 for differing 2-year mortality rates. A subgroup analysis was performed to compare mortality differences between Black and White patients. A posthoc analysis evaluated 5- and 10-year mortality amongst all patients with PC. ResultsAfter propensity matching, mortality risk was significantly lower for patients with PSA < 2 (5.9% vs. 7.5%; RR 0.784; P < .001) when compared to the control cohort. Mortality was significantly higher for all other subsequent PSA intervals > 20, with the lowest risk ratios at PSA 20-100 (24.1% vs. 10.0%; RR 2.419; P < .001) and highest at PSA 200 to 500 (50.4% vs. 10.8%; RR 4.673; P < .001). The sub-group analysis showed that when compared to White patients, Black patients with PSA < 20 had similar mortalities, but had significantly lower 2-year mortality rates at PSA levels ≥ 20. The posthoc analysis of PSA levels and 5- and 10-year mortality of all patients with PC showed similar trends to the 2-year outcomes. ConclusionThis study found that prostate cancer patients with significantly elevated PSA levels have a greater mortality, and Black patients have lower 2-year mortality rates than their White counterparts when matched for PSA levels greater than 20.

Editorial Comment on “Utilization of a Third-party Partnership in Tele-genetic Risk Assessment Program in Genitourinary Oncology”

Editorial Comment on “Utilization of a Third-party Partnership in Tele-genetic Risk Assessment Program in Genitourinary Oncology”

GI and GU fluoroscopy in common post-op oncologic surgeries: what you need to know about this leaky business!

Over the past several years, there has been a trend of decreasing screening or diagnostic fluoroscopic examinations ordered by clinical teams, particularly double contrast gastrointestinal studies. The underlying reason is due to increasing number of endoscopic procedures performed by Gastroenterology and Urology and usage of other imaging modalities, which are either more sensitive and/or offer the ability to obtain tissue for confirmation. Many fluoroscopic studies are now tailored toward patients who have undergone gastrointestinal or genitourinary oncologic surgeries, providing both functional and anatomic information, which are important tools for patient management. Some of these surgeries are very complex and an understanding of the postoperative anatomy and potential pitfalls is important to accurately evaluate for complications. The purpose of this article is to describe techniques and indications for common post-operative fluoroscopic procedures in gastrointestinal and genitourinary oncology while reviewing normal appearances. Complications, with emphasis on postoperative leaks, will be highlighted. Familiarity with the various types of gastrointestinal surgeries and urinary diversion techniques and knowledge of the expected postsurgical appearance is essential for achieving an accurate and prompt diagnosis of complications to allow for adequate treatment and management.

Impact of multidisciplinary tumor boards on clinical decision making in a genitourinary oncology clinic in Mexico city.

e23217 Background: Effective management of genitourinary neoplasms demands a comprehensive approach due to the diverse treatment options and the need for multiple specialists. Multidisciplinary tumor board (MDTB) meetings are a platform for experts to collectively assess and discuss the latest evidence and provide their expertise to tailor treatment plans for patients. Methods: Cases discussed during uro-oncology MDTB meetings at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán in Mexico City over a five-year period (01/2018 to 12/2022) were included. We analyzed the type of neoplasm, reason for case discussion, specialties involved and whether the final decision led to a modification of the original plan. Descriptive statistics were used for analysis. Chi-squared test was used to determinate differences and p value &lt; 0.05 was considered statistically significant. A logistic regression analysis was performed for multivariate analysis. Results: Over the study period, 500 discussions involving 399 patients were included. 87% were men. Prostate, kidney, testicular, upper tract urothelial and bladder carcinoma, represented: 223 (44.6%), 117 (23.4%), 84 (16.8%), 37 (7.4%), 32 (6.4%) of cases, respectively. The majority were presented by urology (319 cases; 63.6%). The primary reason for presentation was surgical decisions in 54.6%. Regarding final conclusions, 55.8% underwent modifications in the treatment plan, 33.2% had no changes and 11% remained inconclusive, requiring further assessment. Individuals with metastatic disease had a higher likelihood of treatment plan changes in 61.6% vs 52.3% (OR 1.46 95%CI 1.01-2.12; p = 0.042). The 163 cases (32.6%) presented during the COVID-19 pandemic were more prone to have treatment modifications 62.6% vs 52.5% (OR 1.51 95%CI 1.03-2.22; p = 0.034); cases presented for surgical reasons during this period were more likely to have a change in treatment modality 74% vs 52.3% (OR 2.6 95%CI 1.34-5.04; p = 0.004). Implementation of results was successful in most cases (72%), with a median time of 3.6 weeks. Reasons for not implementing the plan included: patient decision, treating physician decision, comorbidities, death, and lack of resources. Factors associated with implementation in the multivariate analysis included: male gender (OR 2.81), cases presented during pandemic (OR 2.0), and by urology service (OR 1.92). Conclusions: Among patients presented in our uro-oncology MDTB meetings, more than half will have a change in the original treatment plan, and this agreed strategy is successfully implemented in most individuals. These sessions remained key for patient management during the COVID-19 pandemic.

Utilization of a Third-party Partnership in Tele-genetic Risk Assessment Program in Genitourinary Oncology

ObjectiveTo meet the increasing demands of genetic risk assessment for genitourinary cancers due to expanded clinical guidelines, we established an academic/industry partnership to create a streamlined workflow to overcome the barriers to access to care. Materials and MethodsGenome Medical offers multilingual genetic counseling. A pilot program evaluated patients at risk for hereditary genitourinary syndromes. Between 1/1/20 and 07/01/22, all patients in need of germline testing were offered hybrid in-clinic telehealth pre-test counseling and when indicated, genetic testing. Post-test counseling was offered based on results and encouraged if positive. Testing results, patient satisfaction, and costs were evaluated. ResultsA total of 146 of 182 (80.0%) patients agreed to participate, with 130 (89.0%) completing pre-test counseling. Median age was 65 (range 22-95), with 91% being male and approximately 60% having prostate cancer. The median time from referral to pre-test counseling was 11 days (IQR 7-20). After assessment, testing was recommended for 127 (97.7%) of which 123 (96.8%) completed testing. The median time from testing to result release was 15 days (IQR 10 – 20.8). Forty (32.5%) had post-test counseling. Reimbursement by private insurers increased annually from $17.2 to $52.4. Patient satisfaction was high with a mean Genetic Counselor Satisfaction Scale of 27.9 out of 30. ConclusionsOur program provided high patient satisfaction, rapid access to genetic counseling, prompt genetic testing, timely release of results, and was cost-effective compared to traditional models. This approach is scalable across community and academic settings and across cancer types.

Salvage Therapy for Prostate Cancer: AUA/ASTRO/SUO Guideline Part II: Treatment Delivery for Non-metastatic Biochemical Recurrence After Primary Radical Prostatectomy.

The summary presented herein covers recommendations on salvage therapy for recurrent prostate cancer intended to facilitate care decisions and aid clinicians in caring for patients who have experienced a recurrence following prior treatment with curative intent. This is Part II of a three-part series focusing on treatment delivery for non-metastatic biochemical recurrence (BCR) after primary radical prostatectomy (RP). Please refer to Part I for discussion of treatment decision-making and Part III for discussion of evaluation and management of recurrence after radiotherapy (RT) and focal therapy, regional recurrence, and oligometastasis. The systematic review that informs this Guideline was based on searches in Ovid MEDLINE (1946 to July 21, 2022), Cochrane Central Register of Controlled Trials (through August 2022), and Cochrane Database of Systematic Reviews (through August 2022). Update searches were conducted on July 26, 2023. Searches were supplemented by reviewing electronic database reference lists of relevant articles. In a collaborative effort between AUA, ASTRO, and SUO, the Salvage Therapy for Prostate Cancer Panel developed evidence- and consensus-based guideline statements to provide guidance for the care of patients who experience BCR after initial definitive local therapy for clinically localized disease. Optimizing and personalizing the approach to salvage therapy remains an ongoing area of work in the field of genitourinary oncology and represents an area of research and clinical care that requires well-coordinated, multi-disciplinary efforts.

Adverse Events of Cabozantinib as a Potential Prognostic Factor in Metastatic Renal Cell Carcinoma Patients: Real-World Experience in a Single-Center Retrospective Study.

Cabozantinib, an oral inhibitor targeting MET, AXL, and VEGF receptors, has become a key component of a sequential treatment strategy for clear cell renal cell carcinoma (ccRCC). The purpose of this work is to show that effective management of adverse events (AEs) during cabozantinib treatment and achieving a balance between AEs and treatment efficacy is crucial to achieving therapeutic goals. In this retrospective study, involving seventy-one metastatic RCC (mRCC) patients receiving second or subsequent lines of cabozantinib at the Department of Genitourinary Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, we explored the impact of AEs on overall survival (OS) and progression-free survival (PFS). AEs were observed in 92% of patients. Hypothyroidism during treatment was significantly associated with prolonged OS and PFS (HR: 0.31; p < 0.001 and HR: 0.34; p < 0.001, respectively). The occurrence of hand-foot syndrome (HFS) was also linked to improved OS (HR: 0.46; p = 0.021). Patients experiencing multiple AEs demonstrated superior OS and PFS compared to those with one or no AEs (HR: 0.36; p < 0.001 and HR: 0.30; p < 0.001, respectively). Hypothyroidism and HFS serve as valuable predictive factors during cabozantinib treatment in ccRCC patients, indicating a more favorable prognosis.

Real-world experience on tolerability and safety of relugolix combined with androgen signaling inhibitors in patients with advanced prostate cancer.

85 Background: Relugolix is the first oral GNRH antagonist approved by the FDA in 2021 for the treatment of advanced prostate cancer (PCa). Approval was based on HERO study, which showed a rapid and sustained testosterone suppression superior to that of Leuprolide coupled with a significantly shorter time to eugonad state after discontinuation. Relugolix was associated with a 54% lower risk of major adverse cardiovascular events as compared with Leuprolide. There is very little data available regarding the tolerability safety of Relugolix in combination Enhanced Androgen Signaling Inhibitors (ASI). Here we provide real world experience on the combination of Relugolix and ASIs in patients(pts) with advanced PCa, focusing on safety, tolerability and pharmacodynamic outcome measures. Methods: Houston Methodist Genitourinary Oncology records were reviewed for identification of pts treated with combination Relugolix plus ASI for at least 1 month, from 09/21 to 07/23. Data collected included pts’ baseline and tumor characteristics, cardiovascular and metabolic comorbidities concomitant medication. We recorded Adverse Events, potential Drug Drug Interaction (DDI) and Testosterone (T) and PSA decline. Results: We report 152 advanced hormone-naive PCa pts with median age of 71 (range 48-96). 81% were White or/and Hispanic, 17 % black, 2 % Asian. Majority (90%) had at least 1 cardiovascular risk factor; hypertension (72%), hyperlipidemia (52%), obesity (41 %), diabetes mellitus (26%), coronary artery disease (30%) and atrial fibrillation (13%). ASIs combined with Relugolix included: Darolutamide (78%), Abiraterone (14%), Apalutamide (7%) and Enzalutamide (1%). All but one pt were compliant (99%). Median treatment exposure is 8 months (range 1 -21). All pts had baseline Testosterone &gt;150ng/dL. All pts reached castrate T levels and 90% of patients achieved a T &lt; 20 ng/dL. 55% pts reached PSA &lt;0.1 at median of 4ms, 75% PSA decline &gt; 90% and 91% PSA decline ≥50%. 7% pts discontinued Relugolix due to adverse events. Three pts (2%) had a major adverse cardiovascular event, including one sudden death, one with congestive heart failure, and one with myocardial infarction. Two pts (1%) reported grade 3 fatigue. G3 LFT elevations recorded in 2 pts (1%). No clinical signals of DDI reported. Conclusions: This is the first large original report of the combination of Relugolix with ASIs in real world practice. The combination has a favorable safety and tolerability profile with no new safety concerns. No new DDI concerns were raised. These findings in combination with pharmacodynamic outcome measures of T / PSA support the use of Relugolix in combination with ASIs as standard of care in advanced PCa.

Diversity among editorial boards of genitourinary oncology journals.

481 Background: Several studies have evaluated the ethnic and gender diversity among editorial boards of academic journals in science and medicine, and revealed disparities among representation of historically underrepresented groups. However, the diversity among editorial boards in the field of genitourinary oncology remains unclear. Methods: Using the master journal list from Clarivate, we identified academic journals with a dedicated or primary focus in genitourinary cancers. We then identified the list of editorial board members on each journal’s website. We evaluated economic diversity based off each editor’s country of origin, and classified countries as high income based off World Bank listing for the 2024 fiscal year. We confirmed gender from each editor’s self-reported gender on his or her academic profile. Results: We identified 7 journals with a focus in genitourinary cancers. Among these journals, a total of 485 editor positions were identified, with 397 men (81.86%) and 80 women (16.49%). The gender of 8 individuals (1.65%) could not be confirmed. 28 editors (5.77%) were from countries not identified as high-income countries per World Bank criteria. Conclusions: There are disparities in country of origin among editors of genitourinary oncology journals, with a small proportion of editors originating from countries classified as middle- or low-income. [Table: see text]

Improving health education through a patient-clinician partnered intervention in the patient with genitourinary cancer.

TPS525 Background: Health literacy is associated with health equity, acts as a cornerstone in optimizing patient care and is associated with improved quality of life. The objective of this project is to improve health literacy in patients with genitourinary cancer through a patient-clinician partnered education intervention. Synthesis of Literature Utilization of a targeted education program delivered in-person using voice instruction demonstrated the greatest significant effect on health-related quality of life; the additional of illustration and text further improved this metric. Optimal health related quality of life is associated with greater comprehension of disease and adherence to treatment plan, heightened self-efficacy, and improvement in patient-provider communication. Methods: The intervention is a patient-clinician partnered written form used in conjunction with verbal instruction. The patient documents reasons for the visit and primary concerns to be addressed prior to the provider encounter during the visit. The Action Plan then records the treatment plan and next steps discussed during the visit. A Confidence Ruler acts as a visual representation of patient confidence in the plan of care, acting as a prompt to the provider to ensure adequate information transfer at conclusion of the visit. The patient then retains the written form highlighting the care discussion for reference and recall as needed. Evaluation A five-point Likert test will measure change pre/post intervention; data will be analyzed in a cohort looking at improvement in overall mean. The HRQOL-14 and the CHLT-6 modified will be used to assess baseline health related quality of life and health literacy respectively followed by cohort analysis of the means to determine efficacy outcomes. The primary outcome is to improve health literacy in all patients within a genitourinary oncology clinic population using is a written tool in concurrence with verbal instruction with secondary focus on improving health-related quality of life in the same population. Recommendation Health literacy must be assessed each visit to optimize patient care outcomes and quality of life. Targeted health education must be patient specific and titrated to individual health literacy needs.

Using clinical pathways to identify patient candidates for survivorship in testicular cancer.

492 Background: Dana-Farber Cancer Institute’s (DFCI) Clinical Pathways provide evidence-based decision support for oncologists across a variety of care settings. Data generated by Pathways enable continued cancer care improvement and may also be a tool for identifying patient candidates for survivorship. Here, we explore patients diagnosed with testicular cancer treated with curative intent. Methods: Oncologists at DFCI navigate Clinical Pathways when starting or changing therapies. Each navigation provides discrete clinical data elements about disease (e.g., histology, stage), treatment setting (e.g., line of therapy), and treatment selected. Here, pathway navigation data was used to retrospectively identify patients with testicular cancer who were appropriate for survivorship resources. Eligibility criteria included patients who completed therapy, had not received treatment in 12-24 months since initial therapy navigation, and had a follow-up appointment scheduled. Eligible patients were referred to the testicular cancer survivorship program. Results: Between April 2021 to April 2022, we identified 25 testicular cancer patients treated at DFCI’s primary Longwood campus. Twelve of the 25 patients were identified as eligible for a survivorship referral. Nine of those 12 patients (75%) were successfully identified through the Pathways testicular survival algorithm described above. A Pathways navigation had not been completed by the providers of the 3-remaining survivorship-eligible patients, who were instead identified by EHR treatment plan data. One of the 12 patients screened by the testicular survivorship identification process developed metastatic disease that was not captured by the current algorithm and was then deemed inappropriate for survivorship referral. The remaining 11 patients were contacted and offered survivorship resources. As a reference, the total pathways usage rate between April 2021 to April 2022 for the DFCI genitourinary oncology group was 85% across all GU malignancies, and 74% in testicular cancer. Conclusions: Pathways Navigations can provide robust clinical information about patients, disease, and treatment. This information can be used to identify patients appropriate for survivorship and other clinical resources and trial opportunities in testicular cancer and across other malignancies. The impact of this process requires reliable provider usage of the Clinical Pathways tool.[Table: see text]

Neutropenia - when is GCSF support indicated?

Many systemic treatments used in genitourinary oncology negatively affect haematopoiesis, thus leading to neutropenia. Neutropenic patients are vulnerable to bacterial, and other infections. Often fever is the only symptom in these patients. Neutropenic fever is a major threat for these patients, as it may lead to life-threatening therapy complications that significantly impair the patient's quality of life, Moreover, it may also worsen the prognosis due to therapy delays or necessary dose modifications. Granulocyte colony stimulating factors (GCSF), which can improve neutrophil granulocyte formation, are used both for supportive treatment in febrile neutropenia and for its prophylaxis. The correct indication for such GCSF support depends on the general risk of febrile neutropenia of the therapy used, as well as on individual patient factors and the treatment intent (palliative vs. curative). Based on the current recommendations both of the German and international guidelines, this article aims to provide an up-to-date and practice-oriented overview of the use of GCSF in uro-oncology.

Gender disparity trends in genitourinary oncology academic publishing over the past 3 decades: A bibliometric analysis

To examine gender disparities in genitourinary (GU) oncology academic publishing over the past three decades. We performed a bibliometric analysis of eight academic journals featuring GU oncology research articles: Journal of Clinical Oncology, Cancer, European Journal of Cancer, European Urology, Journal of Urology, BJU International, Prostate Cancer and Prostatic Diseases, and Urologic Oncology: Seminars and Original Investigations. After selecting four time points (1990, 2000, 2010, 2020), we recorded the gender of the first and senior authors and investigated their association with independent variables including publication year, research field, and geographic continent. Results were expressed as odds ratios (ORs) and 95% confidence intervals (CIs). A total of 14,786 articles were included in our analyses. Females comprised 25.7% of first and 18.1% of senior authors. Compared to 1990, there was a trend of progressively higher female first author (OR 1.47 [95% CI 1.27-1.69] in 2000; 2.28 [95% CI 2.00-2.59] in 2010; 3.10 [95% CI 2.71-3.55] in 2020) and senior author positions (OR 1.23 [95% CI 1.05-1.45] in 2000; 1.67 [95% CI 1.45-1.93] in 2010; 2.55 [95% CI 2.20-2.96] in 2020). Compared to GU oncology, non-GU oncology articles were more likely to have female first (OR 2.61, 95% CI 2.38-2.86) or senior authors (OR 2.61, 95% CI 2.35-2.91). Articles from Asia (OR 0.45, 95% CI 0.38-0.51), Africa (OR 0.45, 95% CI 0.22-0.91), and international collaborations (OR 0.62, 95% CI 0.50-0.76) had a lower proportion of female first authors compared to North America. First authors were significantly more likely to be female when senior authors were also female (OR 2.45, 95% CI 2.23-2.69). Despite the bridging trend demonstrated, GU oncology remains a male-predominant discipline. Female leadership and mentorship are pivotal in achieving gender parity in the academic medicine community.

Authorship diversity in global evidence synthesis in genitourinary oncology: A 1998-2022 analysis of cochrane reviews.

e23006 Background: Women and individuals from low- and lower-middle-income countries (LMICs) are under-represented in oncology literature, particularly in high-impact publications. LMIC clinicians face multipronged barriers to impactful research. Unlike practice guidelines of oncology societies like ASCO, authors worldwide can potentially contribute to genitourinary (GU) oncology-related Cochrane Reviews, a potentially representative sample of global evidence synthesis efforts in the field. However, the state of authorship diversity here is unknown, which this study sought to determine. Methods: We retrospectively searched the Cochrane Database, using the filter “Topic: Urology”, and extracted authorship data for all reviews related to genitourinary cancers, published until 25 July 2022. We divided authors’ national affiliation into either low- and lower-middle-income countries (LMICs) or non-LMICs based on World Bank 2022 classification. For reviews having collaboratives listed as group authors, we treated the collaborative belonging to one country as a single author, instead of analyzing all collaborators separately to prevent data skew from several included individuals. Given the higher accuracy of manual web-searches for ascertaining gender over algorithmic estimation, we utilized the former to achieve ≥90% ascertainment. We endeavored to capture at least one webpage that demonstrated their gender or pronouns, like institutional profile, and used historical gender conventions. Results: A total of 54 GU oncology-related reviews, co-authored by a total of 324 authors, were included. 53 reviews were published by the Cochrane Urology Group, while one review was published by the Cochrane Incontinence Group. Countries with the highest representation of co-authors were the US (24.1%), UK (25.3%), Germany (23.5%), South Korea (6.8%), Australia (6.2%), Netherlands (3.7%), China (2.8%), Canada (2.5%), Brazil (1.5%). No authors were from LMICs. Gender could be ascertained for 94.14% (N = 305/324) of co-authors. Women made up 27.5% (N = 84/305) of co-authors, 16.0% (N = 8/50) of first authors, and 16.89% (N = 9/53) of corresponding authors. Conclusions: Women authors are better-represented in Cochrane Reviews related to genitourinary cancers compared to urology-specific journals, while LMICs were noted to have no representation. Global capacity-building efforts are warranted for enhancing the involvement of LMIC urologists with evidence synthesis. Equitable authorship representation may help expand both the focus and the utilization of high-impact evidence synthesis literature.

Exploring Clinical Decision-Making among the Uro-oncology Multidisciplinary Team: A Qualitative Study

ObjectiveThe aim of this qualitative study was to understand the clinical decision-making process among the genitourinary oncology (GU) multidisciplinary team (MDT) and how patients are engaged in the process. Data SourcesA qualitative descriptive study design was conducted and has been reported according to the Consolidated Criteria for Reporting Qualitative Studies (COREQ). Members of the GU MDT were recruited from a metropolitan tertiary hospital and cancer regional center in Australia serving a population of 550,000. Semistructured interviews were conducted, and the audiorecordings were transcribed; an inductive thematic analysis was used to provide insight from multiple perspectives. ConclusionThree themes emerged: (1) the role and scope of the uro-oncology MDT, (2) lack of person-centered clinical decision-making, and (3) the barriers and facilitators. Amid the COVID-19 pandemic, the MDT discussions transitioned to virtual application, which was found to be convenient and efficient and improved attendance. The GU cancer MDT had a prominent biomedical focus that lacked person-centered considerations. Additional research is needed to explore how person-centered outcomes can be incorporated into the clinical decision-making process. Implication for Nursing PracticeThe GU MDT is increasingly important in the care of uro-oncology patients. There appears to be barriers to the implementation of person-centered discussions in the MDT. The effective delivery of multidisciplinary care is contingent on an appropriate mechanism for collaborative communication between all MDT members and patients given the limited involvement of the patient in the MDT itself.

Diversity, equity, and inclusion in genitourinary clinical trials leading to FDA novel drug approval: An assessment of the FDA center for drug evaluation and research drug trials snapshot

To determine the distribution of race and ethnicity among genitourinary oncology trial participants leading to FDA approval of novel molecular entities/biologics. Secondarily, we evaluated whether the proportion of Black participants in clinical trials increased over time. We quired the FDA Center for Drug Evaluation and Research Drug Trials Snapshot (DTS) between 2015 and 2020 for urologic oncology clinical trials leading to FDA approval of novel drugs. Enrollment data was stratified by race and ethnicity. Cochran-Armitage Trend tests were used to examine changes in Black patient participation over years. Nine clinical trials were identified that led to FDA approval of 5 novel molecular entities for prostate and 4 molecular entities for urothelial carcinoma treatment. Trials for prostate cancer included 5202 participants of which 69.8% were White, 4.0% Black, 11.0% Asian, 3.6% Hispanic, <1% American Indian/Alaska Native or Native Hawaiian/Pacific Islander, 3% other. Trials in urothelial carcinoma had 704 participants of which 75.1% were male, 80.8% White, 2.3% Black, 2.4% Hispanic, <1% American Indian/Alaska Native or Native Hawaiian/Pacific Islander, 5% other. Black participation rates over time did not change for urothelial (P=0.59) or the combined cancer cohort (P=0.29). Prostate cancer enrollment trends among Black participant declined over time (P=0.03). Participants in genitourinary clinical trials leading to FDA approval of novel drugs are overwhelmingly white. Involving stakeholders who represent the needs and interests of underrepresented populations in the design and implementation of clinical trials of novel agents may be a strategy to increase diversity, equity, and inclusion among genitourinary clinical trials.

Editorial: Genitourinary (GU) oncology in low-to-middle income countries

Editorial: Genitourinary (GU) oncology in low-to-middle income countries