ObjectiveActive surveillance (AS) is an increasingly utilized strategy for monitoring men with low-risk prostate cancer (PCa) that allows them to defer active treatment (AT) in the absence of cancer progression. Studies have explored reasons for selecting AS and for then switching to AT, but less is known about men’s experiences being on AS. We interviewed men to determine the clinical and psychological factors associated with selecting and adhering to AS protocols.MethodsWe conducted semi-structured interviews with men with a low-risk PCa at two academic medical centers. Subjects had either been on AS for ≥ 1 year or had opted for AT after a period of AS. We used an iterative, content-driven approach to analyze the interviews and to identify themes.ResultsWe enrolled 21 subjects, mean age 70.4 years, 3 racial/ethnic minorities, and 16 still on AS. Men recognized the favorable prognosis of their cancer (some had sought second opinions when initially offered AT), valued avoiding treatment complications, were reassured that close monitoring would identify progression early enough to be successfully treated, and trusted their urologists. Although men reported feeling anxious around the time of surveillance testing, those who switched to AT did so based only on evidence of cancer progression.ConclusionsOur selected sample was comfortable being on AS because they understood and valued the rationale for this approach. However, this highlights the importance of ensuring that men newly diagnosed with a low-risk PCa are provided sufficient information about prognosis and treatment options to make informed decisions.

Key Points Question Do urologic clinicians within the Veterans Health Administration system adhere to the American Urological Association’s antimicrobial prophylaxis guideline for endoscopic urologic procedures? Findings In this cohort study analyzing the medical records of 375 patients at 5 Veterans Health Administration hospitals and the administrative data of 29 530 records throughout the entire Veterans Health Administration system, antimicrobial prescribing was guideline discordant in nearly 60% of patients, the rate of excessive postprocedural antimicrobial use was high, and nearly 40% of records received a median of 3 excess days of antimicrobial therapy. Agreement between these 2 data sources was high. Meaning In patients who underwent common urologic procedures, the rates of guideline-discordant antimicrobial use were high, mainly because of overprescribing of postprocedural antimicrobial agents.

Purpose of Review Malnutrition in a prevalent problem in patients undergoing radical cystectomy. Preoperative malnutrition has been shown to contribute to increased rates of postoperative complications. Given the significant morbidity and mortality of the procedure of radical cystectomy, there is potential for improvement in patient outcomes by nutritional intervention. Recent Findings Prospective studies have demonstrated a reduction in postoperative infection rates in patients who receive supplemental immunonutrition prior to major surgery including radical cystectomy. These initial evaluations of nutritional optimization show significant potential for improved outcomes. Additionally, several studies using enhanced recovery after surgery protocols, which include a preoperative nutritional component, have shown a benefit in reducing length of stay. Summary Emerging literature has shown the benefits of preoperative immunonutrition in improving postoperative outcomes of radical cystectomy. However, further work is needed to determine the best mechanism to optimize nutrition prior to radical cystectomy.

recurrence rates of non-muscle invasive bladder cancer (NMIBC). We report updated results from an ongoing prospective multicenter registry. METHODS: From April 2014 to October 2017, patients from 9 different centers undergoing TURBT for NMIBC were enrolled in a prospective registry. All lesions were assessed using BLC and white light cystoscopy (WLC). Flat lesions were defined as lesions with a flat appearance or appearance consistent with carcinoma-in-situ. Sensitivity and specificity of cystoscopic assessment was determined by comparison to the gold-standard pathologic diagnosis of the individual lesions. RESULTS: A total of 749 patients underwent 933 TURBT and 2,268 separate lesions were identified and resected. Mean age was 73 years and 83% were male. For detection of any malignancy, the sensitivity of BLC (91%) was higher than WLC (79%, p<0.001) and the combination had a sensitivity of 99%. The improved detection rate of any malignancy was notable for flat lesions (BLC 91% vs. WLC 64%, p<0.001). The sensitivity of BLC was also higher for patients with previous BCG treatment (p<0.001). BLC outperformed WLC for all TURBT indications including abnormal cytology. BLC had higher sensitivity compared to WLC for all topographic regions of the bladder; however, the positive predictive value (PPV) of BLC was reduced to 58% for lesions in the prostatic urethra, bladder neck, or trigone compared to 66% PPV for lesions on the anterior, posterior, lateral wall or dome. The number needed to screen with BLC for the diagnosis of an additional malignant lesion was 5. 307 patients had lesions only visible on BLC and 29 of these patients underwent radical cystectomy including 4 patients with tumors identified solely on BLC. CONCLUSIONS: BLC improves detection rates for NMIBC, particularly for flat appearing lesions. The number needed to screen for the diagnosis of an additional malignant lesion was 5. Improved detection rates for BLC are maintained for all TURBT indications and all topographic locations within the bladder.

Interest in surveillance for small renal masses has expanded exponentially due to incidental detection with increased imaging. However, some of these small renal masses behave aggressively. Sarcomatoid pathology is associated with a worse prognosis. Traditionally, it has been thought of as a common pathway of dedifferentiation once a renal malignancy of any histology reaches a threshold size of approximately 3 cm. We report a case of a 65-year-old male with a 2 cm sarcomatoid renal cell carcinoma. To our knowledge, this is the smallest tumor with sarcomatoid differentiation reported in the literature.

Downgrading at RP was observed in 9/94 (9.6%), 12/94 (12.8%), and 19/94 (20.2%) using SB, TB, and SBþTB, respectively. GG concordance was observed in 41/94 (43.6%), 50/94 (53.2%), 57/94 (60.6%) using SB, TB, and SBþTB, respectively. Of the 19 patients downgraded from SBþTB to RP, 4/19 were from GG5 to GG3 (21%), 8/19 (42%) were from GG4 to GG3, and 9/19 (47%) were from GG3 to GG2.CONCLUSIONS: The use of SBþTB improves overall concordance with RP specimens and decreases the rate of upgrading compared to SB or TB alone. However, the unintended consequence of MR/US fusion biopsy is overgrading in up to 20% of patients, which is likely due to oversampling. Given that the method for assigning an overall GG after MR/US fusion biopsy was not fully addressed by the ISUP 2014 Consensus Conference, future studies should focus on identifying a more accurate method for assigning an overall GG in the setting of multiple GG's assigned to each core at MR/US fusion biopsy.