Gettman, Matthew

ABSTRACT Background Prior studies in the pre‐MRI era suggest that patients with NCCN Intermediate and High Risk Grade Group 1 prostate cancer (GG1 PCa) on biopsy have increased risk for adverse oncologic outcomes. However, prostate MRI has altered patient selection for biopsy and improved prostate sampling. Herein, we examined factors associated with adverse pathologic features (APF) at radical prostatectomy (RP) and biochemical recurrence (BCR) among patients with GG1 in the MRI era. Methods A prospectively maintained institutional prostate cancer registry identified patients with GG1 PCa on biopsy who underwent RP from 2000 to 2023, stratified by MRI use. Multivariable logistic regression and Cox regression identified factors associated with APF at RP (GG3‐5, ≥ pT3a, or pN1) and BCR free survival (two consecutive PSA ≥ 0.2 ng/mL), respectively. Results Among patients without MRI ( n = 6732), NCCN risk group was associated with APF, BCR, and distant metastasis. Among 302 patients with GG1 and pre‐operative MRI, NCCN risk group was associated with neither APF nor BCR. Age (OR 1.07, 95% CI 1.01–1.14, p = 0.01), PIRADS ( p = 0.01), and % core positivity (OR 1.02, 95% CI 1.00–1.03, p = 0.04) were associated with APF. Age (HR 1.07, 95% CI 1.01–1.13, p = 0.03), APF (HR 4.36, 95% CI 2.14–8.86, p < 0.001), and positive margins (HR 4.88, 95% CI 2.39–9.98, p < 0.001) were associated with BCR. Conclusions Prior to prostate MRI, NCCN risk groups offered meaningful prognostication among patients with GG1 PCa. However, the utility of NCCN risk groups for GG1 in the MRI era appears limited. Contemporary risk stratification for GG1 should focus on biopsy and MRI characteristics rather than NCCN criteria.

Objective The United Nations defines sustainability as meeting needs of the present without compromising future generations. While often equated to “saving the planet”, sustainability is a diverse topic. Healthcare generates &gt;5% of CO 2 emissions worldwide, yet sustainability efforts in urology are limited. The North Central Section of the American Urological Association (NCSAUA) recently convened a Sustainability Task Force to address this topic. This study queried members on sustainability in urologic practice. Methods Following literature review on sustainability in surgery/urology, a 19-item anonymous REDCap survey was developed and distributed via email to NCSAUA members (N = 1607). The survey assessed current best practice, institutional/personal sustainability, and demographics. Responses were compiled and summarized using descriptive statistics. Results Survey response rate was 4.9% (79/1607). Respondents were most commonly from metropolitan areas (82%), male (71%), and in practice for 5–14 years (29%). Sustainability topics were prioritized as: (1) financial, (2) future workforce, (3) environmental. Over half (56%) reported no institutional sustainability programs or were unaware of them. Instrument (67%), computer (68%), and paper (65%) recycling were supported by a majority of respondents. However, only 28% and 29% of respondents reported current institutional use of instrument and computer recycling, respectively. Telemedicine was infrequent, with most urologists (58%) conducting 0-5% of visits virtually. Conclusions Current institutional and urologic practice emphasis on sustainability is low. Respondents ranked highest sustainability priorities as financial and future workforce. Efforts to address environmental sustainability were also supported, namely reduction of disposables and waste. The findings support the development of targeted programs to advance sustainability priorities widely.

Objective: The aim of this study was to develop a risk score utilizing C-reactive protein (CRP) and procalcitonin to better predict a clinical infection for patients with obstructive urolithiasis. Methods: A retrospective review was performed of patients presenting to the emergency room from December 2017 to February 2019 and who underwent upper urinary tract decompression due to concern for infection in the setting of obstructing urolithiasis. Over 30 clinical parameters were assessed and a composite risk score was created. Univariate and multivariate, forward, stepwise regression analyses were performed to identify predictors of true urinary tract infection (UTI). Results: Ninety-eight patients met inclusion criteria, of which a true UTI was identified in 50 (51%). The standard model of serum white blood cells >15 or temperature >38°C had an area under curve (AUC) of only 0.67 to predict UTI. A multivariable regression-based 4-point risk score (1 point for each of the following: positive urinary Gram stain, perinephric fat stranding on CT, serum CRP >21.95, and serum procalcitonin >0.36) had an AUC of 0.91 to predict UTI. Individually, these components had an AUC of 0.68, 0.68, 0.80, and 0.77, respectively. The chances of confirmed UTI were 8%, 11%, 68%, and 100% for risk scores of 0, 1, 2, and 3 to 4, respectively ( p < 0.001). Conclusions: Only 50% of patients with a suspected UTI and an obstructing stone were ultimately confirmed to have a UTI. A risk score consisting of Gram stain, perinephric fat stranding, CRP, and procalcitonin can improve UTI prediction and warrants further study.