Trimodal therapy was associated with significantly decreased overall survival and cancer-specific survival as well as $335 million in excess spending in 2011. These findings have important health policy implications regarding the appropriate use of high value-based care among older adults with invasive bladder cancer who are candidates for either radical cystectomy or trimodal therapy.

One-half of patients with muscle-invasive bladder cancer who underwent treatment were diagnosed with a psychiatric disorder, which resulted in worse survival outcomes compared with patients who did not have a posttreatment psychiatric diagnosis. This information can be used to inform interventions to educate patients with muscle-invasive bladder cancer regarding the impact of different treatments on mental health. Cancer 2018. © 2018 American Cancer Society.

Purpose: Can focal laser ablation (FLA) of the prostate preserve sexual and urinary function with low morbidity in men with low to intermediate-risk prostate cancer while providing adequate oncologic outcomes? Materials and methods: 120 patients with low to intermediate risk prostate cancer had transrectal FLA done. MRI thermometry controlled the ablation. Procedures were performed between 2013 and 2017. At 6 and 12 months, patients had clinical and MRI follow-up with biopsies of suspicious areas. Patients submitted the Sexual Health in Men (SHIM) survey to evaluate erectile function and the the International Prostate Symptom Score (IPSS) to assess urinary continence and flow.. Multivariate logistic regression identified determinants of positive imaging and biopsies. Two-sided Wilcoxon signed rank test evaluated scores and laboratory values. Results:The median age was 64 and median PSA was 6.05 ng/mL. Eight (6.7%) of patients were African-American. The median follow up period was 34 months (from 17 to 55 months). Gleason score was 3+3 in 37 (30.8%), 3+4 in 56 (46.7%), and 4+3 in 27 (22.5%). AJCC tumor stage was T1c in 89 (74.2%), T2a in 26 (21.7%) and T2b in 5 (4.2%). Tumors were located in the peripheral zone in 108 (73%) of patients. Number of tumors treated were one in 72 (60%) of patients and 2 tumors in 47 (39.2%) of patients. One patient had 3 tumors treated. Twenty (17%) of men had additional oncologic therapy one year after FLA when biopsy confirmed cancer after an abnormal MRI. There was no difference between functional scores pre-and post-ablation.Median SHIM score at baseline was 24 vs 22 at one year (p=0.51) and the IPSS score was 6.5 at baseline and 6.0 at one year (p=0.12). The median PSA fell to 3.25 at 12 months (p<0.001). Tumor diameter above the median (Odds Ratio (OR), 3.36; 95% CI, 1.41-7.97) was the only significant predictor for a positive post-treatment MRI..

IMPORTANCEEarlier studies on the cost of muscle-invasive bladder cancer treatments lack granularity and are limited to 180 days.OBJECTIVE To compare the 1-year costs associated with trimodal therapy vs radical cystectomy, accounting for survival and intensity effects on total costs. DESIGN, SETTING, AND PARTICIPANTSThis population-based cohort study used the US Surveillance, Epidemiology, and End Results-Medicare database and included 2963 patients aged 66 to 85 years who had received a diagnosis of clinical stage T2 to T4a muscle-invasive bladder cancer from

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