Prostate cancer continues to be one of the leading causes of cancer mortality in men in the developed world, so there is an urgent need to improve diagnosis and treatment. Our best route to doing this is to identify the pathways that drive prostate cancer and build a clear understanding of the mutations associated with tumours at all stages of the disease.

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Objective
To determine how the use of United States Medical Licensing Examination (USMLE) score cutoffs during the screening process of the Urology Residency Match Program may affect recruitment of applicants who are underrepresented in medicine (URM).

Materials and Methods
Deidentified data from the Association of American Medical Colleges' (AAMC) Electronic Residency Application Service (ERAS) system was reviewed, representing all applicants to our institution's urology residency program from 2018 to 2022. We analyzed self-reported demographic variables including race/ethnicity, age, sex/gender, as well as USMLE Step 1 and Step 2 scores. Chi-square tests and ANOVA were used to determine the association between race/ethnicity and other sociodemographic factors and academic metrics. Applicants were stratified according to USMLE Step 1 cutoff scores and the distribution of applicants by race/ethnicity was assessed using a Gaussian nonlinear regression fit.

Results
A total of 1258 applicants submitted applications to our program during the 5-year period, including 872 males (69.3%) and 386 females (30.7%). Most applicants were White (43.5%), followed by Asian (28.3%), Hispanic/Latino (11.7%), and Black (7.0%). There was an association between race/ethnicity and USMLE scores. Median USMLE Step 1 scores for White, Asian, Hispanic/Latino, and Black applicants were 242, 242, 237, and 232, respectively (P < .001). As cutoff score increases, percentage of URM applicants decreases.

Conclusion
The use of cutoffs based on USMLE scores disproportionately affects URM applicants. Transitioning from numeric scores to pass/fail may enhance holistic review processes and increase the representation of URM applicants offered interviews at urology residency programs.

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Alain Kaldany,¹ Hiren V Patel,² Aditi Gore,¹ Haris Ahmed,¹ Saum Ghodoussipour,³ Ji Hae Park,¹ Danielle Velez Leitner,¹ Thomas L Jang⁴

1. Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
2. Department of Urology, University of California, San Francisco, San Francisco, CA.
3. Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
4. Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.

Source: Effect of United States Medical Licensing Examination Score Cutoffs on Recruitment of Underrepresented Applicants in the Urology Match

Prostate cancer is still the leading cause of male cancer-related mortality globally. While Androgen Deprivation Therapy (ADT) initially displays promise in patients, metastatic prostate cancer inevitably transforms into a lethal state due to treatment resistance, often within two years. Therefore, deciphering this conundrum is a major medical need.

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Small cell or neuroendocrine prostate cancer (NEPC) is a rare and aggressive disease characterized by a low serum prostate-specific antigen (PSA) and visceral metastatic disease at diagnosis. NEPC can present as de novo metastatic disease (<1% of prostate cancers) or as treatment-emergent NEPC (T-NEPC), which arises from pre-existing metastatic castrate-resistant prostate cancer (mCRPC) (estimated to occur in 17-30% of mCRPC cases). On a histologic level, NEPC is morphologically similar to the oat cell or intermediate cell appearance of small cell lung cancer (SCLC) with nearly 90% of cases staining positive for a neuroendocrine marker.

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