Boris Gershman

Purpose Repeat transurethral resection (re-TURBT) is recommended for all patients with high-risk bladder cancer to improve staging and oncologic outcomes. However, contemporary evidence on the role of re-TURBT is lacking. We therefore examined the contemporary rates of upstaging at re-TURBT and the association of re-TURBT with disease recurrence and progression. Materials and methods We identified patients with an incident diagnosis of high-grade Ta, low-grade T1 and high-grade T1 urothelial carcinoma of the bladder between 2010 and 2022. The association of re-TURBT with disease recurrence and progression was evaluated using Cox regression. Rates and predictors of residual tumor and upstaging at re-TURBT were evaluated using univariable logistic regression. Results A total of 328 patients were included, of whom 88 (27%) underwent re-TURBT. Among those who underwent re-TURBT, 9 (10%) were upstaged to ≥ T2, while 39 (44%) were found to have residual non-muscle invasive disease. Median follow-up time was 13 and 24 months for RFS and PFS, respectively. In a multivariable analysis, re-TURBT was not associated with a significant difference in disease recurrence or progression compared with no re-TURBT. In unadjusted analysis, a higher Charlson index was associated with an increased risk of upstaging and residual tumors. A greater number of tumors was associated with increased risks of residual tumor at re-TURBT. Conclusions In a contemporary cohort of patients with bladder cancer, the rate of upstaging at re-TURBT was 10%, lower than historical studies. The rate of residual non-muscle invasive disease remains high at 44%. Re-TURBT was not associated with a statistically significant difference in disease recurrence or progression.

Background Existing literature underscores racial and sociodemographic disparities in prostate cancer screening (PCS) in the USA. Objective To evaluate whether traditional PCS disparities are evident within a health safety-net institution tailored to support traditionally underserved populations. Design A retrospective cohort study using electronic health-record data was conducted at an urban safety-net institution. Participants Male patients aged 51–70 years with a primary care provider (PCP) visit from 2018 to 2019 were included. Main Measures The primary outcome was PCS, defined as receiving a Prostate Specific Antigen (PSA) blood test within the study period. Investigated patient characteristics included self-reported race and ethnicity, language, insurance, marital status, median household income, serious mental illness (SMI), substance use disorder (SUD), and family history of prostate cancer (PCa). Bivariate analyses using chi-squared tests and multivariable logistic regression analyses were performed to compare PCS rates between the groups. Key Results The cohort included 10,059 men, of which 40.4% had PCS. In total, 57.3% of the study population was of non-White race and 61.4% of non-North American/European ethnicity. A total of 31.2% had limited English proficiency (LEP), 17.8% had SMI, and 13.2% had SUD. In multivariable analysis of race, Black patients (OR 1.96, 95%CI 1.71–2.24, p < 0.001) and Hispanic patients (OR 1.51, 95%CI 1.3–1.76, p < 0.001) had significantly higher odds of PCS than White patients. Patients with LEP did not exhibit significantly lower screening rates than English-speaking patients (ORs 0.99–1.17). Conclusions Within a healthcare institution designed and implemented to meet the needs of underserved populations, traditional racial and sociodemographic disparities in PCS are not evident. Graphical Abstract