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SES AUA 2022

SES AUA 2022

SES AUA 2022: Prolonged Opioid Use Following TURBT: Insurance Claims Review of High-Risk Prescribing to Opioid-Naive Patients

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(UroToday.com) The 2022 Southeastern Section of the AUA’s annual meeting included a bladder cancer session and Dr. Benjamin Croll discussing prolonged opioid use following transurethral resection of bladder tumor (TURBT) specifically for opioid-naïve patients. Urologic and general surgical data have shown in numerous settings that opioid-naïve patients prescribed postoperative opioids are at increased risk of developing opioid dependence and persistent use. Bladder cancer patients represent a high-risk group for opioid dependence due to the frequency of surgical procedures. The objective of this study was to use MarketScan insurance commercial claims and Medicare-eligible supplemental databases to identify whether receiving initial post-TURBT opioids resulted in an increased likelihood of prolonged use. Dr. Croll and colleagues additionally sought to identify opioid prescribing trends over time and in different treatment groups.

SES AUA 2022: Same Day Discharge in Robotic Assisted Radical Prostatectomy as Part of a Perioperative Pathway at a Single Institution

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(UroToday.com) The 2022 Southeastern Section of the AUA’s annual meeting included a prostate cancer session and Dr. Eric Wendel discussing same day discharge in robotic radical prostatectomy as part of a perioperative pathway. Same day discharge after robotic assisted radical prostatectomy has been documented with relatively low complication rate [1, 2]. As part of a perioperative pathway, and in part due to the COVID-19 pandemic, Dr. Wendel and colleagues have initiated offering same day discharge for patients. At the 2022 SESAUA annual meeting, Dr. Wendel presented results evaluating their institution’s National Surgical Quality Improvement Program (NSQIP) readmissions and complication rates between same day discharge patients and standard of care.

SES AUA 2022: Gender Disparities in the Clinical Trials and Real-World Utilization of Systemic Therapy in the Management of Urothelial Carcinoma

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(UroToday.com) The 2022 Southeastern Section of the AUA’s annual meeting included a bladder cancer session and Dr. Nick Batra discussing gender disparities in the clinical trials and real-world utilization of systemic therapy in the management of urothelial carcinoma. Urothelial carcinoma of the bladder is more common in men than women by a 3:1 ratio. However, women have an increased risk of (i) muscle invasive bladder cancer, (ii) disease recurrence, (iii) disease progression, and (iv) cancer-specific mortality, as well as a decrease in overall survival. The objective of this study was to determine if gender disparities exist within the clinical trials utilized to guide recommendations from the National Comprehensive Cancer Network (NCCN) for the use of systemic therapy in the management of urothelial carcinoma, as well as assess the relationship between gender and systemic therapy administration in the management of urothelial carcinoma in the United States.

SES AUA 2022: Racial Variation in MRI-Guided Prostate Biopsy Significant Cancer Detection Among Black and White Men

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(UroToday.com) The 2022 Southeastern Section of the AUA’s annual meeting included a prostate cancer session and Dr. Callan Brownfield discussing racial variation in MRI-guided prostate biopsy significant cancer detection among Black and White men. Prostate biopsies guided by MRI have superior cancer detection rates compared to traditional ultrasound-only guided biopsies. The objective of this study was to evaluate comparative cancer detection of MRI-guided prostate biopsies based on self-reported patient race (White versus Black).

SES AUA 2022: Family History Of Prostate Cancer Is Not Independently Associated With Differences In Oncologic Outcomes Between African American And Caucasian Men

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(UroToday.com) The 2022 Southeastern Section of the AUA’s annual meeting included a prostate cancer session and Dr. Aaron Bradshaw discussing a potential association of family history of prostate cancer and differences in oncologic outcomes for African American and Caucasian men. Prostate cancer outcomes generally differ between Caucasian and African American populations. However, it is unknown whether a positive family history of prostate cancer has a similar effect on oncologic outcomes in each population. The objective of this study was to compare the impact of family history on prostate cancer outcomes in African American and Caucasian men.

SES AUA 2022: Examining The Intersections Of Race, Ethnicity, And Insurance Status With Metastatic Prostate Cancer At Presentation

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(UroToday.com) The 2022 Southeastern Section of the AUA’s annual meeting included a prostate cancer session and Dr. Caleb Bercu examining the intersections of race, ethnicity, and insurance status with metastatic prostate cancer at presentation. One out of eight men will be diagnosed with prostate cancer in the United States, with the most critical indicator for treatment modality and mortality being the stage of prostate cancer at diagnosis. Currently, the intersectional relationships of race, socioeconomic status, and insurance status with the presentation of metastatic prostate cancer have yet to be elucidated. The aim of this study was to identify inequities between socioeconomic and demographic variables related to presentation of stage IV prostate cancer.

SES AUA 2022: African American Men Have Comparable Risk Of Upgrading On Active Surveillance: A Prospective Observational Prostate Cancer Study

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(UroToday.com) The 2022 Southeastern Section of the AUA’s annual meeting included a prostate cancer session and Dr. Christopher Koller discussing a prospective observational prostate cancer study assessing the potential for upgrading on active surveillance among African American men. For several decades, active surveillance has been the preferred management option for patients with localized low risk prostate cancer without high risk of prostate mortality. The hypothesis for this study was that race is not associated with Gleason upgrading on active surveillance, and that active surveillance is a safe management option for both African American and Caucasian American appropriately selected patients.

SES AUA 2022: COVID-19’s Drastic Impact On Adhering Patients To An Active Surveillance Protocol For Prostate Cancer

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(UroToday.com) The 2022 Southeastern Section of the AUA’s annual meeting included a prostate cancer session and Dr. Christopher Koller discussing the impact of COVID-19 on adhering patients to an active surveillance protocol for prostate cancer. Active surveillance is a protocol widely accepted for low risk prostate cancer to prevent over-treatment while monitoring for progression with strict surveillance protocols including repeat biopsies. The COVID-19 pandemic reached the United States on January 20, 2020 and spread rapidly. Urologists at the Southeast Louisiana Veterans Health Care System (VA) were unable to perform biopsies between March 14, 2020 and June 20, 2020. The purpose of this study was to describe the effects of the COVID-19 pandemic on patients on an active surveillance protocol at the VA.

SES AUA 2022: Optimizing Therapy for Locally Advanced Prostate Cancer

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(UroToday.com) The 2022 Southeastern Section of the AUA’s annual meeting included a state-of-the-art lecture by Dr. Brian Chapin discussing optimizing therapy for locally advanced prostate cancer. Dr. Chapin started by highlighting that the disease states of prostate cancer have become quite detailed, based on castration status and line of therapy received:

SES AUA 2022: Preliminary Results Of A Single Arm Phase II Trial Of Intraoperative Intravesical Mitomycin C During Nephroureterectomy For Urothelial Carcinoma

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(UroToday.com) The 2022 Southeastern Section of the AUA’s annual meeting included a bladder cancer session and Dr. Hiroko Miyagi discussing preliminary results of a single arm phase II trial of intraoperative intravesical mitomycin C during nephroureterectomy for urothelial carcinoma. Intravesical recurrence occurs in ~40% of patients during follow-up, however a single post-operative instillation of intravesical chemotherapy reduces the risk of bladder tumor recurrence within the first year following radical nephroureterectomy.  However, there is a paucity of evidence regarding the timing of administration of intravesical chemotherapy. A retrospective review of 51 patients who underwent radical nephroureterectomy had a bladder tumor recurrence rate of 16% (intra-operative mitomycin C) versus 33% (post-operative instillation of mitomycin C).1 As such, the objective of this study was to evaluate the impact of intraoperative instillation of mitomycin C during nephroureterectomy on bladder tumor recurrence.

SES AUA 2022: Extramural Venous Invasion: A Novel Magnetic Resonance Imaging Biomarker For Adverse Pathology In Bladder Cancer

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The 2022 Southeastern Section of the AUA’s annual meeting included a bladder cancer session and Dr. Allison Feibus discussing extramural venous invasion as a novel MRI biomarker for adverse pathology in bladder cancer. Extramural venous invasion identified on MRI is a known biomarker for adverse pathology in rectal cancer, but not yet studied in bladder cancer. In this study, Dr. Feibus and colleagues explored the feasibility of identifying extramural venous invasion in patients with bladder cancer and its utility in detecting adverse pathology.

SES AUA 2022: Are Metachronous Bladder Tumors Predictive of Upper Tract Urothelial Carcinoma Recurrence in Patients Treated with Radical or Endoscopic Surgery

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(UroToday.com) The 2022 Southeastern Section of the AUA’s annual meeting included a bladder cancer session and Dr. Christian Ericson discussing whether metachronous bladder tumors are predictive of upper tract urothelial carcinoma recurrence in patients treated with radical or endoscopic surgery. Upper tract urothelial carcinoma comprises 5% of urothelial cancers, and treatment with nephroureterectomy or endoscopically with ureteroscopy with dual laser ablation using holmium and neodymium fibers are current management strategies. Regular surveillance for recurrence is performed post operatively with cross sectional imaging or by ureteroscopy. Patients with metachronous bladder tumors after a nephroureterectomy have been shown to have lower 5-year overall survival, as well as increased risk of contralateral recurrence.1,2 Metachronous bladder tumors are often identified during surveillance and there is a paucity of literature defining their role in predicting upper tract recurrence of upper tract urothelial carcinoma. The objective of this study was to describe the significance of metachronous bladder tumors in predicting recurrence of upper tract urothelial carcinoma in patients who have received endoscopic versus radical management of their disease.

SES AUA 2022: Association Between Visibly Complete TURBT and Pathologic Downstaging Following Neoadjuvant Chemotherapy and Radical Cystectomy For Muscle-Invasive Bladder Cancer

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(UroToday.com) The 2022 Southeastern Section of the AUA’s annual meeting included a bladder cancer session and Dr. Bryce Baird discussing the association between visibly complete TURBT and pathologic downstaging following neoadjuvant chemotherapy and radical cystectomy for muscle-invasive bladder cancer. Neoadjuvant chemotherapy followed by radical cystectomy is a standard of care in patients with muscle-invasive bladder cancer. However, there are conflicting data regarding the potential oncologic benefit of a visibly complete TURBT prior to neoadjuvant chemotherapy and radical cystectomy. Furthermore, the improved local staging offered by bladder MRI has called into question the value of a TURBT prior to neoadjuvant chemotherapy for patients with imaging evidence of muscle-invasive tumors. The primary aim of this study was to evaluate if a visibly complete TURBT is associated with pathologic outcomes after neoadjuvant chemotherapy and radical cystectomy.

SES AUA 2022: Primary Chemoablation of Low-Grade Intermediate-Risk Non-Muscle-Invasive Bladder Cancer Using UGN-102, A Mitomycin-Containing Reverse Thermal Gel (OPTIMA II): A Phase 2B, Open-Label, Single-Arm Trial

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(UroToday.com) The 2022 Southeastern Section of the AUA’s annual meeting included a bladder cancer session and Dr. Angela Smith discussing results of OPTIMA II, a phase 2b, open-label, single arm trial assessing primary chemoablation of low-grade intermediate risk non-muscle invasive bladder cancer (NMIBC) using UGN-102. The standard of care for low-grade intermediate-risk NMIBC is transurethral resection of bladder tumors (TURBT) under general anesthesia. However, low-grade intermediate-risk NMIBC is a highly recurrent malignancy, and patients often endure repeated surgeries that may be associated with significant postoperative and long-term morbidity. OPTIMA II was designed to evaluate efficacy and safety of UGN-102, a mitomycin containing reverse thermal gel, as primary chemoablative therapy in patients with low-grade intermediate-risk NMIBC.

SES AUA 2022: Implications of Postponing Cancer Treatment During the Pandemic

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(UroToday.com) The 86th Annual Meeting of the Southeastern Section of the American Urological Association was host to a State-of-the-Art Lecture by Dr. Zachary Klaassen, MD, MSc discussing implications of postponing cancer treatment during the Coronavirus Disease 2019 (COVID-19) pandemic.