Introduction Racial and socioeconomic disparities in health access and outcomes for many conditions are well known. However, for time-sensitive high-acuity diseases such as traumatic injuries, disparities in access and outcomes should be significantly diminished. Our primary objective was to characterize racial disparities across majority, mixed-race, and minority hospitals for African American (AA) versus white males with high-grade splenic injuries. Methods Data from the National Trauma Data Bank was utilized from 2007 to 2015. A total of 24 855 AA or white males with high-grade splenic injuries were included. Multilevel mixed effects regression analysis was used to evaluate disparities in outcomes and resource allocation. Results Mortality was significantly higher for AA males at mixed-race (odds ratio [OR] 1.6; 95% CI 1.3-2.1; P < .001) and minority (OR 2.1; 95% CI 1.5-3.0; P < .001) hospitals, but not at majority hospitals. At minority hospitals, AA males were significantly less likely to be admitted to the intensive care unit (OR 0.7; 95% CI 0.49-0.97; P = .04) and experienced a significantly longer time to surgery (IRR 1.5; P = .02). Minority hospitals were significantly more likely to have failures from angiographic embolization requiring operative intervention (OR 2.2; P = .009). At both types of nonmajority hospitals, AA males with penetrating injuries were more likely to be managed with angiography (mixed-race hospitals: OR 1.7; P = .046 vs minority hospitals: OR 1.6; P = .08). Discussion While multiple studies have shown that minority hospitals have increased mortality compared to majority hospitals, this study found this disparity only existed for AAs.

Introduction Racial and socioeconomic disparities in health access and outcomes for many conditions is well known. However, for time-sensitive high-acuity diseases such as traumatic injuries, disparities in access and outcomes should be significantly diminished. Our primary objective was to characterize racial disparities across majority, mixed-race, and minority hospitals for African American ([AA] vs White) males with high-grade splenic injuries. Methods Data from the National Trauma Data Bank were utilized from 2007 to 2015; 24 855 AA or White males with high-grade splenic injuries were included. Multilevel mixed-effects regression analysis was used to evaluate disparities in outcomes and resource allocation. Results Mortality was significantly higher for AA males at mixed-race (OR 1.6; 95% CI 1.3-2.1; P < .001) and minority (OR 2.1; 95% CI 1.5-3.0; P < .001) hospitals, but not at majority hospitals. At minority hospitals, AA males were significantly less likely to be admitted to the intensive care unit (OR 0.7; 95% CI, 0.49-0.97; P = .04) and experienced a significantly longer time to surgery (IRR 1.5; P = .02). Minority hospitals were significantly more likely to have failures from angiographic embolization requiring operative intervention (OR 2.2, P = .009). At both types of nonmajority hospitals, AA males with penetrating injuries were more likely to be managed with angiography (mixed-race hospitals: OR 1.7; P = .046 vs minority hospitals: OR 1.6; P = .08). Discussion While multiple studies have shown that minority hospitals have increased mortality compared to majority hospitals, this study found this disparity only existed for AAs.

INTRODUCTION AND OBJECTIVES: Randomized controlled trials (RCTs) have demonstrated male circumcision (MC) to be protective for HIV infection. In 2016, WHO renewed its mission of 27 million circumcisions in sub-Saharan males aged 10-29 years old by 2021. The objective of this study was to identify patient motivators for undergoing MC to help guide future MC campaigns in Africa.METHODS: Males aged 10 years or greater, in good health were enrolled in a study examining no-flip ShangRing circumcision conducted at Homa Bay and Vipingo, Kenya were included in this study. Demographic factors, patient motivations, and presenting complaints related to their foreskin were evaluated in this analysis. Multivariate logistic regression analysis was performed using STATA 14 (StataCorp, College Station, TX).RESULTS: A total of 574 males underwent ShangRing MC from Homa Bay (n¼340) and Vipingo (n¼234). Among participants, the primary reason for MC was hygiene in 262 (46.3%); social or religious reasons in 146 (25.8%); HIV protection in 149 (26.3%); social stigma in 5 (0.8%); or as part of medical therapy, preventing cervical cancer, cracking of foreskin during intercourse, and for self-esteem in 1 (0.2%) each. On multivariate analysis, HIV prevention was a stronger predictor for MC among those with college education (OR 2.56, p¼0.01). Religion or social reasons were more common motivators for Muslim men (OR 5.36, p<0.001). Hygiene was the most common motivator for Christian men (p<0.001). Conditions related to the foreskin leading to MC included penile adhesions in 88 (15.3%), difficulty retracting foreskin in 46 (8%), difficulty protracting foreskin in 22 (3.8%), urethral discharge in 2 (0.3%), dysuria in 2 (0.3%), and scrotal swelling in 1 (0.2%).CONCLUSIONS: In this study, we determined that reasons for undergoing MC vary significantly depending upon religious beliefs, and level of education. Given the demographic diversity in sub-Saharan Africa, it is important to consider these factors when engaging men to consider MC.

INTRODUCTION AND OBJECTIVE:There is ongoing discussion if the negative predictive value of mpMRI during active surveillance (AS) is sufficient to omit prostate biopsies. The next question is, what to do with patients having serial negative MRIs. The AUA guidelines only recommend to perform biopsies within 2 years after diagnosis and do not specify if MRI has a role in preventing unnecessary biopsies during active surveillance. The aim of this study is to add to the current evidence and to evaluate the predictive value of consecutive negative MRIs.METHODS: The PRIAS study is a multicenter prospective study providing an evidence-based recommendation on how to perform AS for patients with low-risk prostate cancer (PCa). The inclusion criteria and recommended follow up schedule are available on www. prias-project.org. All patients with consecutive negative MRIs during AS were included in the current analysis.RESULTS: In total, 180 men had two consecutively negative MRI (negMRI) during AS. The median time between the negMRI was 16 (interquartile range (IQR) 11-25) months. The median PSA at the time of the last negMRI was 6.0 (IQR 4.2-8.6) ng/ml. A total of 68 (38%) men underwent systematic biopsy (SBx) at the last negMRI showing no PCa in 29 patients (43%), PCa grade group (GG) 1 in 35 patients (51%) and PCa GG 2 in 4 patients (6%). Additionally, one patient underwent extraprotocollair PSMA PET/CT targeted prostate biopsies at the time of the last negMRI and was reclassified to PCa GG 3. Follow up data of 158 patients without reclassification at last negMRI who continued AS was available (Figure 1). Median follow up after last negMRI was 21 (IQR 10-34) months. 36 patients underwent additional biopsies of which 10 patients upgraded to GG2 and 3 patients upgraded to GG!3. All upgrading to GG!3 was detected by TBx on subsequent MRI.CONCLUSIONS: Patients with repeated negMRI during AS represent a low-risk group, however reclassification to GG2 cannot completely be excluded as, although very rare, reclassification to GG!3. This questions the need to perform SBx in these patients. Monitoring however, including repeat MRI should continue since progression on the long term cannot be excluded. It is reassuring that all upgrading to GG!3 was detected on MRI.

INTRODUCTION AND OBJECTIVE: Life expectancy (LE) is a critical but often overlooked factor in prostate cancer treatment decision making, as evidenced by high rates of overtreatment among those with limited LE. There is a lack of data regarding patient perspectives on how LE information ought to be communicated in treatment consultations. We sought to develop patient-centered strategies to optimize communication of LE through interviews of men considering treatment.METHODS: We recruited men with low-and intermediate-risk prostate cancer to participate in 30-60-minute semi-structured interviews following treatment consultations. Patient views on importance of LE, whether and how it had been mentioned, barriers to discussing LE, confidence in LE estimate, and ideal mode of communication were ascertained using open-ended questions. We assessed frequency of responses to identify common attitudes.RESULTS: Of 20 total subjects, the majority (15/20, 75%) recalled that LE had been discussed during treatment consultations. Level of detail of LE estimates ranged from vague generalization (e.g. "long") (5/15, 33%) to number of years (e.g. "you will live until 90") (3/15, 20%) to specific probability of survival at a timepoint ("33% probability of living 15 years") (7/15, 47%). Of those who did not recall hearing about LE, the majority (4/5, 80%) thought it would have been helpful. The predominant barrier to hearing LE was anxiety (12/20, 60%), which subjects noted could be reduced by providing a range of years or depersonalizing the information (e.g. "LE for patients like you"). The vast majority (15/19, 77%) had low to moderate confidence in LE estimates in general and noted that explaining how LE was calculated (9/20, 45%) or including their health conditions into the calculation (5/20, 25%) would make them more confident. When offered a hypothetical scenario to determine the ideal mode of communication of LE, the majority preferred a specific number of years (12/19, 63%) over probability of survival at a timepoint (4/19, 21%) or vague generalization (3/19, 16%). The vast majority of subjects (18/20, 80%) felt that LE information should always be provided in treatment consultations.CONCLUSIONS: Men with prostate cancer in our study strongly endorsed inclusion of detailed LE information in treatment consultations. They generally desired to be given LE in a number of years format to optimize understanding. To maximize confidence in LE estimates, explaining the calculation method and incorporating patientspecific medical conditions was preferred.