bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gender disparities in the National Institutes of Health funding for genitourinary oncology.
Authors: Farooq Muhammad Zain , Khan Sara , Zahid Ibrahim , Sohail Aruba , Jaglal Michael Vishal 
Published: March 2023

264 Background: Traditionally, women are under-represented in academic fields and thus less likely to receive grants and funds. Here we assessed the National Institutes of Health (NIH) funding trend in allocation of R401 grants in Genito-urinary oncology (GU) stratified by gender. Methods: The data were retrieved from the NIH RePORTER (Research Portfolio Online Reporting Tools Expenditure) using GU-related search terms from 2018-2021. The gender was categorized using Genderize. The number of citations, publications, H-index, and seniority were obtained from Scopus and Web of Science in September 2022. Consumer Price Index was used to adjust funding amount to 2021 equivalent U.S. dollars. Linear regression was used for analysis. Results: A total of 873 NIH-funded R01 grants amounting to $388.5 million were awarded for GU research. Women (n= 206; 23.6% [95% CI: 20.8%-26.4%]) received fewer grants than men (n= 667; 76.4% [95% CI: 73.6%-79.2%]). Trending from 2018 to 2021, there was no significant difference in the number of grants awarded among both men (173 to 181, p=0.78) and women (50 to 53, p=0.92) within their groups. Similarly, there was no significant change in the grant amount (in millions) awarded among men (74.2 to 78.7, p=0.47) and women (23.6 to 22.4, p=0.30). Prostate cancer accounted for the greatest proportion of grants (n=689; 78.9% [95% CI: 76.2%-81.6%]), amounting to 304.4 million in 4 years. Of the 269 co-Principal Investigator (PIs), 240 (89.2% [95% CI: 85.5%-92.9%]) were men and 29 (10.8% [95% CI: 7.1%-14.5%]) were women. Male PIs compared to female PIs had a higher no. of publications (135 vs 106, p<0.01). Funding amount was significantly associated with the number of publications (β=0.05; p<0.01), seniority (β=0.10; p=0.015), institution (p<0.01) and degrees (p=0.03). However, there was no significant association with gender (β=0.05; p=0.17). Conclusions: Our analysis shows continued gender disparity in R01 awards as only 1 in 5 grants were awarded to women during the fiscal years of 2018-2021. Thus, concerted efforts are required to bridge this gap and promote gender equity. [Table: see text]
Perioperative outcomes of radical prostatectomy for advanced stage, node positive, and metastatic prostate cancer.
Authors: Simhal Rishabh Kumar , Wang Kerith Ruoyao , Shah Yash , Mark James Ryan , Shah Mihir S , Gomella Leonard G. , Lallas Costas D. , Chandrasekar Thenappan 
Published: March 2023

270 Background: Historically, surgical management with radical prostatectomy (RP) has been a definitive treatment option only for localized prostate cancer (PCa). However, recent studies suggest an overall survival benefit to treating the primary tumor with radiation therapy in metastatic PCa (mPCa). Therefore, RP may have a role in treating mPCa, but the perioperative safety of that remains unclear. Here, we aim to compare the perioperative outcomes of RP for locally advanced, node positive, and metastatic PCa using the National Surgical Quality Improvement Project (NSQIP) database. Methods: RPs performed between 2019-2020 were identified in NSQIP and the corresponding Prostatectomy-Targeted Participant Use File. Cases were grouped into six distinct categories: T1N0M0-T2N0M0; T3N0M0; T4N0M0; T1-3N1M0; T4N1M0; and T1-4N0-1M1. Baseline age, race, and medical comorbidities were compared between the groups. Patients were then further grouped into T1-2N0M0 versus T3-4N0M0 cases to compare the effect of locally advanced disease, TanyN1M0 versus TanyN0M0 to compare the effect of node-positivity, and TanyN0M1 versus TanyN0M0 to compare the effect of metastases. 30-day outcomes, operative time, hospital length-of-stay, 30-day mortality, readmissions, reoperations, major complications, minor complications, and surgery-specific complications were compared between groups. Results: Pathologic staging was available for 5,248 RPs. Baseline demographics were largely similar, with the exceptions of increased Black race, diabetes, and smoking in the node-positive-group and increased age in the T4 group. There was a slightly higher rate of minor complications in the locally advanced (T3-4N0M0) versus localized (T1-2N0M0) group, but no significant difference in major complications, 30-day mortality, readmissions, or rectal injuries. In comparison to node-negative patients (T1-4N0M0), node-positivity (T1-4N1M0) was associated with longer operative time, LOS, and incidence of 30-day renal failure, but was otherwise not associated with a higher rate of any complication. Compared to non-metastatic cases (T1-4N0M0), metastatic cases (T1-4N0M1) were associated with a higher rate of bleeding, prolonged-NG-tube use, ureteral obstruction, and LOS. Conclusions: RP for patients with locally advanced, node positive, and metastatic prostate cancer appears to be safe; it is not associated with significantly higher rates of 30-day mortality or major complications compared to RP for localized prostate cancer. Given the potential survival benefit in treating the primary tumor in advanced disease, there may be a role for RP in treating patients with advanced PCa.
Associations between patient sociodemographic factors and non-treatment for localized prostate cancer.
Authors: Novosel Madison , Smani Shayan , Marks Victoria A. , Jeong Farah , Sprenkle Preston , Leapman Michael 
Published: March 2023

307 Background: Although definitive treatment is associated with improved survival for aggressive prostate cancer, a significant number of patients do not receive treatment. To identify gaps in practice, we sought to evaluate sociodemographic factors associated with non-treatment by clinical risk strata in the contemporary era. Methods: We performed a retrospective study of patients with prostate cancer using the National Cancer Database. A total of 616,479 patients diagnosed with localized prostate (cT1-4N0M0) cancer from 2010 to 2017 were included in the analysis. We used descriptive statistics and multivariable logistic regression to evaluate factors associated with non-treatment, stratifying analyses by D’Amico clinical risk criteria. Results: The mean patient age at diagnosis was 65 years. 29.0% were diagnosed with low, 43.7% with intermediate, and 28.4% with high-risk prostate cancer. There were 71,848 (11.7%) who did not undergo initial treatment, including 46,269 (64.4%) with low, 18,376 (25.6%) with intermediate, and 7,203 (10.0%) with high-risk disease. Overall, non-treatment increased for low-risk (11.6% versus 47.0%), intermediate (4.4% versus 9.7%) and high risk (3.4% versus 4.7%). Compared with White patients, Black patients had lower odds of definitive treatment. This effect was more pronounced for patients with high (OR 0.63, 95% CI 0.59-0.67) than intermediate (OR 0.78, 95% CI 0.75-0.82) risk disease. Asian patients had lower odds of treatment compared with White patients across all disease risk strata (OR 0.82, 95% CI 0.77-0.87). There were lower odds of treatment among American Native/Alaskan Native versus White patients with high-risk prostate cancer (OR 0.58, 95% CI 0.39-0.85). Uninsured (OR 0.41, 95% CI 0.39-0.44, p<0.001), and Medicaid-insured (OR 0.69, 95% CI 0.65-0.72, p<0.001) patients were significantly less likely to be treated overall. The effects of Black race and non-treatment did not differ by insurance status (p-value for interaction=0.237). Conclusions: Patient race and insurance are significantly associated with non-treatment for aggressive prostate cancer.
Increased prostate volume on transrectal ultrasound and magnetic resonance imaging are potential risk factors for acute urinary retention following transperineal prostate biopsy.
Authors: Sandberg Maxwell , Whitman Wyatt , Hingu Janmejay , Thakker Parth , Rong Anita , Bercu Caleb , Greenberg Jacob W. , Davis Ronald , Hemal Ashok , Tsivian Matvey 
Published: March 2023

308 Background: Prostate biopsy is one of the most frequently performed procedures in urology. Recently, there has been a nationwide shift towards offering transperineal (TP) biopsies due to a reduced rate of infectious complications compared to the transrectal (TR) route. While infection may be reduced, TP biopsy is not without complication, most notably, acute urinary retention (AUR). Estimates vary as to the true rate of AUR following TP biopsy. Further, some studies have reported higher rates of AUR following TP biopsy than TR. Here we report the rate of AUR following TP biopsy at a single academic institute and relate it to risk factors for developing AUR. Methods: Retrospective case-control study. All biopsies performed with TR ultrasound (TRUS) guidance using TP technique under general anesthesia in dorsal lithotomy with a grid template. TRUS volumes were recorded during the procedure, and MRI volumes were calculated by a trained radiologist pre-biopsy. Charts of men undergoing TP biopsy from 2012 to present were reviewed. AUR was defined as patients who reported inability to urinate within 72 hours post-biopsy and underwent thorough evaluation including PVR and relevant H&P and required catheter placement. Independent samples t-test was run to relate AUR to risk factors pre/post-biopsy. Results: A total of 767 TP biopsies were completed in the study window, but not all had TRUS/MRI data. Total rate of AUR was 5.48% (N=42/767). Risk factors for AUR were increased TRUS (p=0.009, [6.49, 42.30]) and MRI prostate volumes (p=0.027, [2.90, 43.13]). Age, number of cores taken, and number of previous biopsies were not associated with AUR. Conclusions: While data is scant, the rate of AUR at our institution is consistent with current estimates in the literature. There is a growing body of evidence that the rate of AUR post-TP biopsy is higher than TR, but more investigation is needed. There is also a gap in the literature on risk factors predicting AUR after TP biopsy, however our findings are relatively consistent with the few studies currently published. Urologists must recognize patients presenting for TP biopsy with large volume prostates and consider altering management to prevent AUR. [Table: see text]
Influence of molecular imaging on patient selection for treatment intensification prior to salvage radiation therapy for prostate cancer: A post hoc analysis of the PROPS trial.
Authors: Tremblay Samuel , Alhogbani Mofarej , Weickhardt Andrew , Davis Ian D. , Scott Andrew Mark , Hicks Rodney J. , Metser Ur , Chua Sue , Davda Reena , Punwani Shonit , Payne Heather Ann , Tunariu Nina , Ho Bao , Young Sympascho , Bauman Glenn , Emmett Louise , Pouliot Frederic 
Published: March 2023

316 Background: The impact of molecular imaging (MI) on patient management after biochemical recurrence (BCR) following radical prostatectomy has been described in many studies. However, it is not known if MI-induced management changes are appropriate. This study aimed to determine if androgen deprivation therapy (ADT) management plan is improved by MI in patients who are candidates for salvage radiation therapy. Methods: Data were analyzed from the multicenter prospective PROPS trial evaluating PSMA/Choline PET in patients being considered for salvage radiotherapy (sRT) with BCR after prostatectomy. We compared the pre- and post-MI ADT management plans for each patient and cancer outcomes as predicted by the MSKCC nomogram. A higher percentage of predicted BCR associated with ADT treatment intensification after MI was considered as an improvement in a patient’s management. Results: Seventy-three patients with a median PSA of 0.38 ng/mL were included. In bivariate analysis, a positive finding on MI (local or metastatic) was associated with decision to use ADT with an odds ratio of 3.67 (95% CI, 1.25 to 10.71; p=0.02). No factor included in the nomogram was associated with decision to use ADT. Also, MI improved selection of patients to receive ADT based on predicted BCR after sRT: the predicted nomogram 5-year biochemical-free survivals were 52.5 % and 43.3%, (mean difference, 9.2%; 95% CI 0.8 to 17.6; p=0.03) for sRT alone and ADT±sRT subgroups, while there was no statistically significant difference between subgroups before MI. Conclusions: PSMA and/or Choline PET/CT before sRT can potentially improve patient ADT management by directing clinicians towards more appropriate intensification.
Development and validation of a novel radiomic model for predicting post-treatment prostate cancer recurrence.
Authors: Huynh Linda My , Taylor Olivia , Wang Shuo , Baine Michael 
Published: March 2023

317 Background: Multiparametric magnetic resonance imaging (mpMRI)-derived radiomic features have been shown to capture sub-visual patterns for quantitative characterization of tumor phenotypes in prostate cancer (PC) patients. The present study seeks to develop, test, and validate a mpMRI-derived radiomic model for predicting PC recurrence following initial treatment. Methods: mpMRI was obtained from 76 patients who had undergone radical prostatectomy for treatment of localized PC. All patients had >2 years follow-up with monitoring via prostate specific antigen (PSA). Patients with neo-adjuvant/adjuvant treatment were excluded. Regions of interest were manually delineated on each mpMRI and radiomics features were extracted. Stability on histogram matching was assessed via interclass correlation coefficients (ICC) and a pre-established feature selection pipeline excluded redundant features. The most important and non-redundant features were then aggregated into a radiomic model against a primary outcome of PC recurrence. Patients were randomly split 3 to 1 to training and validation datasets and the training dataset was used to iteratively train and test the best parameters for a Random Forest predictive model. The model with the best parameters as determined by receiver-operator curve (ROC) analysis was then applied to the validation set. ROC analysis was conducted and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were reported. Results: Clinicodemographic of the 76 patients included in analysis are displayed in Table. 924 radiomic features were initially extracted and 75 (8.1%) features were determined to be stable and robust following histogram matching. Based on the figure selection pipeline, six features were determined to be important and non-redundant. These features were iteratively tested in the training dataset (n=56) and the model with the best parameters yielded a mean ROC with area under the curve (AUC) of 0.95 ± 0.06. After application to validation dataset (n=20), the model yielded an AUC of 0.67. Sensitivity, specificity, PPV, and NPV were 33%, 100%, 40% and 100%, respectively. Conclusions: Radiomic analysis of 76 PC patients yielded six mpMRI-derived radiomic features significantly correlated with PC recurrence following primary treatment. When aggregated and applied to a validation dataset, the final radiomic model yielded 100% specificity in predicting PC recurrence. These findings represent excellent potential for the development of a radiomic-based diagnostic tool with high positive predictive value in identifying patients at high-risk for PC recurrence at time of initial PC diagnosis. Future projects will seek to incorporate patient demographics and disease characteristics to further improve model sensitivity and validation of this model will be pursued with an external cohort of patients.[Table: see text]
Association between sociodemographic factors and diagnosis of advanced prostate cancer in early life.
Authors: Smani Shayan , Novosel Madison , Jeong Farah , Marks Victoria A. , Sprenkle Preston , Leapman Michael 
Published: March 2023

32 Background: A subset of patients are diagnosed with lethal prostate cancer early in life, before PSA screening is typically initiated. To identify opportunities for improved detection we evaluated patient clinical and sociodemographic factors associated with advanced versus localized prostate cancer diagnosis across the age spectrum. Methods: We conducted a retrospective cohort study using the National Cancer Database, identifying patients diagnosed with prostate cancer in 2004-2016. We compared characteristics of patients diagnosed at advanced (cN1 or M1) versus localized (cT1-4N0M0) stage. Using multivariable logistic regression, we evaluated the associations among patient clinical and sociodemographic factors and advanced diagnosis, stratifying patients by age as <55 (before screening is usually initiated), 55-65, 65-75, and >75 years. Results: We identified668,486 patients who met inclusion criteria (mean age at diagnosis=64.6 years), including 33,455 (5.0%) with advanced disease at diagnosis. Uninsured (odds ratio, OR=3.78, 95% confidence interval, CI 3.56-4.02) and Medicaid-insured (OR 2.84, 95% CI 2.70-3.00) versus commercially insured patients were more likely to be diagnosed with advanced disease, however this effect was more pronounced for younger patients. Among patients <55 years, uninsured (OR 4.63, 95% CI 4.08-5.25) and Medicaid (OR 3.59, 95% CI 3.22-3.99) versus commercial insurance were associated with greater odds of advanced cancer at diagnosis. Similarly, residence in the lowest versus highest income quintile (OR 1.21, 95% CI 1.04-1.40) was associated with increased odds of advanced prostate cancer in patients <55 years. Black versus White race was associated with increased odds of advanced prostate cancer at diagnosis later in life (OR 1.15, 95% CI 1.11-1.19), however race was not significantly associated with stage of prostate cancer in those <55 years (p=0.29). Conclusions: Sociodemographic disparities in advanced stages of prostate cancer diagnosis were more pronounced in younger patients, particularly with respect to insurance status. These findings may support greater attention to differential use of early prostate cancer screening by health insurance.
Analysis of false-positive biopsy results of PIRADS 4 lesions in multiparametric magnetic resonance imaging of the prostate: Experience from a single nonacademic center using cognitive fusion.
Authors: Mota Augusto C. A. , de Souza Bianca Carla Azevedo , Novaes Marco Antonio Soares , do Amaral Maria Estela Pompeu , de Souza Maiara Ferreira , Athanazio Daniel Abensur 
Published: March 2023

321 Background: Multiparametric magnetic resonance imaging (mpMRI) of the prostate has been increasingly used in the algorithm of the initial diagnosis of patients suspected to harbor prostate cancer (PCa) with the aim of improving the selection of patients who really need a biopsy. Yet patients with PI-RADS 5 lesions almost always have cancer found in their prostates, the same is not true for patients with PI-RADS 4. In this study we sought to describe pathological findings in target biopsies of PI-RADS4, and to identify clinical data that could predict those patients with benign findings. Methods: A retrospective study was conducted in a data bank collected prospectively from December 2015 through April 2022 in a single nonacademic center. The whole series consist of 547 patients, all of whom had a mpMRI of the prostate (reports as per PI-RADS version 2) followed by cognitive fusion prostate biopsy performed by a single, experienced radiologist. All biopsy specimens were read by a specialist in urological pathology. Out of these, 259 had PI-RADS 4 lesion, and 83 had PI-RADS 5. Results: We found a false positive rate of 29% and 3.7% for any cancer in PI-RADS 4 and 5 lesions, respectively. Different histologic patterns were observed among target biopsies. At multivariate analysis, PIRADS lesion ≤ 6 mm and previous negative biopsy were independent predictors of false positive PI-RADS4 lesions. The 76 cases showed normal histology (n = 22), a combination of chronic inflammation, reactive epithelium, and glandular atrophy (n = 18), glandular atrophy (n = 9), stromal proliferation consistent with nodular hyperplasia (n =7), a combination of chronic inflammation, reactive epithelium and glandular atrophy (n = 6), chronic inflammation (n = 4) and HGPIN (n = 10). The small number (n=3) of false PI-RADS5 lesions precluded further analyses. Conclusions: Benign findings are common in PI-RADS4 lesions and most of them did not show obvious glandular or stromal hypercellularity as expected in hyperplastic nodules. Size ≤ 6 mm and previous negative biopsy predict higher probability of false positive results in patients with PI-RADS 4 lesions.[Table: see text]
De novo prostate cancer in renal transplant recipients: A single-center study.
Authors: Sridhar Arthi , Yohannan Binoy , Kaur Harmanpreet , Maithel Neha 
Published: March 2023

326 Background: Renal transplant recipients (RTRs) are at an increased risk of developing solid organ malignancies. Given improved allograft survival and life expectancy, the incidence of prostate cancer (PC) in RTRs appears to be increasing. Previous studies have reported the incidence of PC among RTRs to be between 0.3% and 3.24%. Limited data is available on the clinical characteristics, treatment, predictive markers, and outcomes of PC in RTRs. Methods: We performed a single-center retrospective study of male RTRs who developed PC. We collected the following data on RTRs who underwent transplantation between January 1, 1999, and December 31, 2019: baseline demographics, cause of end-stage renal disease (ESRD), duration of dialysis prior to RT, type of RT (cadaveric vs. living donor), immunosuppressive regimen, interval from RT to diagnosis of PC, stage of PC, type of treatment received, allograft survival, and overall survival (OS) were collected. Results: Among 1093 male RTRs, 15 (1.37%) developed PC. The median age at diagnosis of PC was 60 (range, 49-75) years. Subject races were African American (n=7), Hispanic (n=3), White (n=3), and other (n=2). The median duration from transplant to diagnosis of PC was 72 (range, 12-156) months. PC was diagnosed at stage I in 13 patients, stage II in 1 patient, and stage IV in 1 patient. The management of these patients consisted of local radiation (LR) alone in 6 patients, LR with leuprolide therapy in 6 patients, and radical prostatectomy alone in 1 patient. The patient with stage IV PC was treated with leuprolide and abiraterone acetate and remains progression free at follow-up of 41 months. The 5-year OS for this cohort of patients was 73.3%. Allograft function was preserved in 13 patients 12 months after diagnosis of PC. No PC-related mortality was noted. Conclusions: The incidence of PC in our analysis appears to be consistent with prior published studies. Most of our RTRs with PC had early-stage disease with excellent 5-year survival. The current standard-of-care treatment modalities for PC appear to be effective in the management of these patients. Allograft function was preserved in the majority of RTRs with PC in this study. Further research is required to evaluate the predictive factors for developing PC in RTR.