Urology Practice最新文献

Introduction: Socioeconomic status contributes to disparities in kidney cancer outcomes. We examined the association between Area Deprivation Index (ADI) and overall mortality (OM) and cancer-specific mortality (CSM) in a North American statewide cohort.

Methods: By using the Michigan Department of Health and Human Services database, we included patients diagnosed with renal cell carcinoma between 2004 and 2019. ADI was assigned based on residential census block group, ranked as a percentile of deprivation relative to the national level. Individuals were categorized into quartiles, based on national quartile value, where the fourth (ADI: 75-100) represented those in the most deprived areas. Cumulative incidence function was used to compare CSM and OM with ADI quartile. Competing-risk regression and Cox regression analysis tested the association of ADI on CSM and OM, respectively.

Results: We included 9210 patients with a median age of 60 (IQR: 52-67) years. Among those, 35.6%, 31.2%, 25.4%, and 7.8% were from the fourth, third, second, and first ADI quartile, respectively. Compared with the first ADI quartile, those in the fourth were younger (median age: 59 vs 60) and diagnosed more often with clear cell and papillary renal cell carcinoma (respectively, 70% vs 67% and 23.1% vs 20.9%; all P < .0001). At 10 years, CSM hazard was 25.6% vs 26.4% (P = .02) and OM hazard was 60.7% vs 72.8% (P < .0001) for patients in the first vs fourth ADI quartiles. Multivariable analysis showed that, comparing with the first ADI quartile, patients in the second, third, and fourth had, respectively, 1.62-, 1.45-, and 1.38-fold higher CSM hazard (P = .03) and 1.32-, 1.41-, and 1.58-fold higher OM hazard (P < .001).

Conclusions: The ADI was significantly associated with kidney cancer outcomes, with patients in more deprived areas exhibiting a higher mortality risk.

Introduction: Socioeconomic status and geographical location contribute to disparities in localized prostate cancer (PCa) treatment. We examined the impact of Area of Deprivation Index (ADI) on initial treatment type for localized PCa in a North American cohort.

Methods: We performed a retrospective analysis of patients diagnosed with localized PCa treated within the state of Michigan between 2010 and 2022 with available ADI data. The latter was assigned based on the residential census block group, ranked as a national deprivation percentile. Patients were categorized into 3 treatment groups: radical prostatectomy (RP), radiation therapy (RT), and Other treatment. Using multinominal logistic regression, we assessed ADI impact on treatment choice. After excluding patients without cT, International Society of Urological Pathology grade, and/or PSA, we stratified by D'Amico risk classification and repeated the regression analysis in each subgroup.

Results: The cohort consisted of 46,481 patients. Among those, 17.7% were non-Hispanic Black men. Regarding treatment, 21,152 (45.51%) patients underwent RP, 9713 (20.89%) received RT, and the remaining 15,616 (33.59%) underwent Other treatments. Median (IQR) national ADI percentile was 58 (38-79), and it was 55 (37-76), 62 (41-83), and 59 (38-82) for the patients treated with RP, RT, and Other, respectively (P < .0001). At multivariable analysis, ADI was significantly associated with the type of received treatment. For each 10-unit increase in ADI, patients were 3% more likely to receive RT and 2% less likely to receive an RP, compared with Other treatment (odds ratio [OR], 1.03, 95% CI, 1.02-1.04; P < .001 and OR, 0.98, 95% CI, 0.97-0.99; P < .001, respectively). When stratified by D'Amico risk classification, among patients with known PSA, grade, and stage (25,571 patients), 6976 (27.28%) were low risk, 12,329 (48.21%) were intermediate risk, and 6266 (24.50%) were high risk. At multivariable analysis, for each 10-unit increase in ADI percentile, low-risk patients were 7% more likely to receive RT compared with other treatments (OR, 1.07, 95% CI, 1.04-1.10; P < .001). Although among intermediate-risk and high-risk patients with PCa, each 10-unit increase in ADI was associated with 4% and 6% decreased likelihood of receiving RP, respectively, compared with other treatments (OR, 0.96, 95% CI, 0.95-0.98; P = .001 and OR, 0.94, 95% CI, 0.91-0.97; P <.001).

Conclusions: Patients living in developed areas were more likely to receive RP, while those living in the most disadvantaged areas received higher rates of RT. Understanding neighborhood influence on initial localized PCa treatment is essential in guiding interventions and reducing disparities.

Introduction: Multiparametric MRI (mpMRI) has improved detection of clinically significant prostate cancer (csPCa). However, negative biopsies still occur, and limited evidence exists to guide follow-up after a negative biopsy. This study aimed to identify clinicopathological factors associated with detection of csPCa within 2 years of an initial negative biopsy informed by mpMRI.

Methods: We identified patients with a negative biopsy informed by mpMRI who underwent at least 1 repeat biopsy within 2 years. Individuals with prior prostate cancer were excluded. The primary outcome was csPCa, defined as Gleason Grade Group 2 or higher, on repeat biopsy. Baseline and follow-up characteristics were analyzed, and logistic regression models were constructed.

Results: Among 1790 patients with an initial negative biopsy, 176 underwent repeat biopsy and 33 (18.8%) were diagnosed with csPCa. These patients had a higher PSA density, Prostate Imaging Reporting and Data System (PI-RADS) 4 to 5 on baseline MRI, and absence of inflammation on initial biopsy. The model using these features produced an AUC of 0.752. High-grade prostatic intraepithelial neoplasia and atypical small acinar proliferation on baseline biopsy were not associated. Replacing initial imaging findings with persistent PI-RADS 4 or 5 findings on repeat mpMRI modestly improved performance (AUC = 0.780).

Conclusions: Higher PSA density, PI-RADS 4 to 5 on baseline mpMRI, and absence of inflammation on baseline biopsy were associated with detection of csPCa. Persistent PI-RADS 4 to 5 on repeat mpMRI further increased risk. High-grade prostatic intraepithelial neoplasia and atypical small acinar proliferation were not associated with csPCa detection.