Prostate cancer in transgender women.

INTRODUCTION: As the transgender patient population continues to increase, urologists and other providers who treat genitourinary malignancies will increasingly encounter cases of prostate cancer in transgender women. Little exists in the current literature to help summarize the challenges and opportunities which face this unique patient population. Similarly, little exists to provide guidance on how we may best diagnose, manage, and follow transgender women diagnosed with prostate cancer. We sought to review the available literature in hopes of providing a resource for providers moving forward. MATERIALS AND METHODS: We collaboratively reviewed the currently available literature, guidelines, and statements of best practice to compile a comprehensive review of this emerging and important topic. RESULTS: Transgender persons face numerous systemic barriers to care with well documented increased risks of suicide and poor health outcomes. Though uncommon, the diagnosis of prostate cancer in transgender women is often associated with significant disease. While many options for management remain in line with standard guidelines, the unique aspects of care in this population-prior/current hormone usage, gender-affirming surgical procedures etc.-must be considered. Surgical, radiation, and hormonal treatments all play a potential role in appropriate treatment. Longitudinal studies are currently lacking and clinical trials are often structured with exclusive language which may lead to further marginalization of this patient population. CONCLUSION: Transgender persons will almost certainly continue to grow as a population encountered and treated by healthcare professionals. Better training and understanding are needed to ensure all healthcare needs are met as best possible. Prostate cancer represents an area in which great strides may be made to improve both diagnosis and treatment. Urologists, and others who manage urologic cancers, must take the lead to improve the care of transgender persons with genitourinary malignancies.

Exploring Patterns of Mitomycin C Use in Community Practice Urology.

INTRODUCTION: Although evidence supports the use of mitomycin C after transurethral bladder tumor resection in reducing recurrent disease, its adoption has been limited. Examinations of claims data may help in exploring patterns of care and barriers to use. Thus, we analyzed a contemporary population based cohort to determine recent trends in mitomycin C use in community practice urology. METHODS: Using the Premier Hospital database we identified patients who underwent transurethral bladder tumor resection between January 1, 2003 and December 31, 2015. Multivariable logistic regression was used to evaluate the association of receiving mitomycin C with patient, hospital and surgical characteristics. We also assessed the effect of age and comorbidities on use. RESULTS: Mitomycin C use increased from 3.3% in 2003 to 5.5% in 2013 and then decreased to 4.5% in 2015. After adjusting for baseline characteristics mitomycin C was more likely to be used in patients who were older (65 years or more vs less than 65: OR 1.31, 1.01-1.67, p <0.05). Patients with a higher Charlson comorbidity index had lower odds of mitomycin C use (1 or more vs 0: OR 0.86, 0.75-0.98, p <0.05 and more than 2 vs 0: OR 0.84, 0.72-0.98, p <0.05). Top 75% annual surgeon volume (yes vs no: OR 1.68, 1.34-2.1, p <0.001) was associated with mitomycin C use. CONCLUSIONS: Mitomycin C remains underused, although its use has increased. Patients with increased comorbidities are less likely to receive mitomycin C while high volume surgeons are more likely to administer mitomycin C. Understanding patterns of care in mitomycin C use may inform quality improvement initiatives and guide future efforts to promote appropriate use.