Inverse stage migration with increase of unfavorable PCa continues in most contemporary North American patients. However, a paradigm shift to treat LR patients with less invasive methods (NLT) was demonstrated. Contrary, HR patients increasingly undergo LT. Future studies with long-term follow-up might answer if inverse stage migration vs. treatment trends translate into different PCa metastases/mortality rates vs. proposed NLT benefits, particularly related to USPSTF-recommended reduced PSA screening.

Background: Urinary tract infections (UTIs) are among the most common bacterial infections worldwide and have become more difficult to treat over the years. Inappropriate antibiotic use has led to increased antibiotic resistance. Materials and methods: We examined 1921 urine culture samples from a single hospital and analyzed them for bacterial spectrum and antibiotic susceptibility. We further analyzed changes in the rates of detected bacteria and of the sensitivity of these uropathogens to antibiotics over the years. Results: In our hospital-based analysis, cystitis was the most frequently diagnosed UTI in women (76%) and men (79%). Escherichia coli (48%) was the most commonly identified uropathogen. Samples demonstrated an increase in the proportion of E. coli (p < 0.001) and a decrease in Enterococcus faecalis (p < 0.001) over the study time period. Antimicrobial susceptibility analysis showed an increase over time in the number of isolates with resistance to ampicillin/sulbactam (p < 0.001) and to third-generation cephalosporins cefotaxime (p = 0.043) and ceftazidime (p < 0.001). Conclusions: Ampicillin/sulbactam and third-generation cephalosporins are antibiotics frequently used in the treatment of UTIs. When selecting an optimal antimicrobial treatment regimen for patients with UTIs, it is imperative to understand regional and timedependent differences in the prevalence of various uropathogens and antimicrobial resistance patterns. Therefore, continuous surveillance of local pathogen and antimicrobial susceptibility patterns for frequently used antibiotics should be prioritized.

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PCa biopsies among beneficiaries receiving care from ACO and non-ACO providers.METHODS: Using 20% Medicare claims sample, we selected men eligible for PSA screening aged 66 years and older. In 2014 beneficiaries were attributed to ACO and non-ACO providers using the Medicare Shared Savings Program (MSSP) algorithm. Subsequently, beneficiaries from 2010 were retroactively attributed to ACO and non-ACO providers. Propensity adjusted rates and difference-in-differences analyses were utilized to compare trends in PSA screening and prostate biopsies between beneficiaries attributed to ACO and non-ACO providers in the pre-ACA and post-ACA era. Analyses were stratified by the age groups: 1) 66-69 year olds and 2) 70þ years old, the latter comprising the "low value" care category.RESULTS: For the same ACO and non-ACO providers, PSA screening rates were administered in 62% and 61% of patients in 2010 vs. 56% and 54% in 2014, respectively. Similarly, for ACO and non-ACO providers prostate biopsies were performed in 4.7% and 4.4% of patients in 2010 vs. 5.4% and 5.2% in 2014, respectively. Our difference-in-differences analyses revealed that PSA screening rates (p¼0.3) and prostate biopsy rates (p¼0.7) did not significantly vary for patients who received care at ACO and non-ACO providers. In analyses restricted to men aged 70 years or older, PSA screening rates in patients treated by ACO and non-ACO providers were 54% and 54% in 2010 vs. 46% and 46% in 2014, respectively. Prostate biopsy rates in this elderly population treated by ACO and non-ACO providers were 4.3% and 4.1% in 2010 vs. 4.8% and 4.6% in 2014, respectively. The difference-in-differences analyses in this subset of older patients also demonstrated a lack of significant effect between ACO and non-ACO providers for both PSA screening (p¼0.2) and prostate biopsy utilization (p¼0.5).CONCLUSIONS: Overall, the trends in PSA screening and biopsies were similar between 2010 and 2014 at both ACO and non-ACO providers, regardless of patient age. This suggests that the implementation of ACOs did not have an impact on the use of PSA screening or prostate biopsies.