Anjaney Kothari

Objectives: Prostate cancer is the most frequently diagnosed cancer among men, with Latino patients experiencing higher cancer-specific mortality compared to non-Hispanic populations. We evaluated prostate cancer outcomes across distinct Latino subpopulations. Methods: We retrospectively reviewed a single tertiary comprehensive cancer center database of patients with localized prostate cancer treated with radical prostatectomy from 2003 through 2020. Latino patients were subcategorized as Mexican, South/Central American (SCA), or Caribbean (Puerto Rico and Cuba). Non-Hispanic White (NHW) patients served as the reference group. Results: Overall, 7084 patients were included, of which 78% (n = 5518) were NHW and 10% (n = 679) were Latinos. Compared to NHW, Latino patients were younger at the time of surgery (median 62 vs. 64 years) and had higher median BMI (median 28.8 vs. 27.5 kg/m²), median baseline PSA (6.2 vs. 5.5 ng/mL), and D’Amico intermediate- (44% vs. 42%) and high-risk disease rates (16% vs. 13%) (all p < 0.001). Among Latino patients, Mexican patients had higher median baseline PSA (6.7 vs. 6.1 vs. 6.1 ng/mL, p = 0.005) compared to SCA and Caribbean patients. Survival analysis revealed shorter 5-year (97% vs. 99%) and 10-year (89% vs. 96%) overall survival (OS) rates in Mexican Latinos compared to non-Mexican Latinos (both p < 0.05). The 5-year (77% vs. 80% vs. 95%) and 10-year (63% vs. 65% vs. 86%) biochemical recurrence-free survival rates were shorter for Mexican patients compared to SCA and Caribbean patients. On multivariable analysis, SCA subpopulation status was associated with significantly better OS, and pathologic T stage > T2 was associated with worse biochemical recurrence-free survival. Conclusions: We identified significant differences in prostate cancer outcomes for different Latino subpopulations, underscoring the importance of population disaggregation in this ethnic group.

Barriers to cancer care, including transportation and Internet insecurity, are of special concern in low-resource communities. A patient-centered, telehealth-based, barrier-focused lay navigator program may mitigate such barriers. We share insights from a quality improvement project wherein we developed and delivered a lay navigator program in a low-resource community in the Mojave Desert. We identified 68 patients scheduled for lung cancer detection/management at our institution, 55 of whom completed a barrier assessment, enrolled in the program, and could be evaluated. Participants were predominantly older (76%), White (84%), had a cancer diagnosis at enrollment (69%), and lived in socioeconomically disadvantaged neighborhoods. Thirty-three (60%) patients had ≥1 barrier, the most common being transportation (31%), Internet (24%), and financial (24%) concerns. These barriers were more frequent among patients with a lung cancer diagnosis at enrollment. Crisis-focused and after-hours encounters were more frequently initiated by older and advanced cancer patients. Transportation and Internet concerns were significantly associated with missed appointment rates. While the scope of our findings is limited, the delivery of a telehealth-based, barrier-focused lay lung navigator program in this low-resource setting was feasible. Neighborhood context and barrier resource planning are important for the implementation of similar programs within our institution’s clinical practice network.

Urothelial carcinoma is an aggressive entity that is associated with significant morbidity, but there have been major advances in both our understanding of and treatment options for patients with this disease. In this review, the authors focus on novel therapeutic and diagnostic approaches in the perioperative setting, with an emphasis on patient‐centered and individualized care. For urothelial carcinoma of the bladder (UCB), advances in nonplatinum‐based therapies, specifically immunotherapy and antibody–drug conjugates, have expanded the therapeutic arsenal for patients with muscle‐invasive UCB in both the neoadjuvant and adjuvant settings to improve survival outcomes. Given the significant morbidity of extirpative surgery (radical cystectomy and urinary diversion), there have also been greater efforts to evaluate bladder‐sparing protocols and improve the selection of patients for surgery and their postoperative recovery. The authors review special considerations for organ‐sparing surgery in females, geriatric co‐management, and enhanced recovery after surgery protocols. For upper tract urothelial carcinoma, there has been increasing recognition of its unique diagnostic and therapeutic challenges, including risks of renal functional loss. There have been advances in molecular profiling that have demonstrated various genomic differences between upper tract urothelial carcinoma and UCB, with treatment implications. This article reviews studies evaluating perioperative care that focused on optimizing therapeutic approaches, including neoadjuvant/adjuvant chemotherapy and immunotherapy, as well as nephron‐sparing strategies in carefully selected cases.