Cells often alter metabolic strategies under nutrient-deprived conditions to support their survival and growth. Characterizing metabolic reprogramming in the tumor microenvironment (TME) is of emerging importance in cancer research and patient care. However, recent technologies only measure a subset of metabolites and cannot provide in situ measurements. Computational methods such as flux balance analysis (FBA) have been developed to estimate metabolic flux from bulk RNA-seq data and can potentially be extended to single-cell RNA-seq (scRNA-seq) data. However, it is unclear how reliable current methods are, particularly in TME characterization. Here, we present a computational framework METAFlux (METAbolic Flux balance analysis) to infer metabolic fluxes from bulk or single-cell transcriptomic data. Large-scale experiments using cell-lines, the cancer genome atlas (TCGA), and scRNA-seq data obtained from diverse cancer and immunotherapeutic contexts, including CAR-NK cell therapy, have validated METAFlux’s capability to characterize metabolic heterogeneity and metabolic interaction amongst cell types.

Background Despite consensus guidelines, many men with low‐grade prostate cancer are not managed with active surveillance. Patient perception of the nomenclature used to describe low‐grade prostate cancers may partly explain this discrepancy. Methods A randomized online survey was administered to men without a history of prostate cancer, presenting a hypothetical clinical scenario in which they are given a new diagnosis of low‐grade prostate cancer. The authors determined whether diagnosis nomenclature was associated with management preference and diagnosis‐related anxiety using ratings given on a scale from 1 to 100, adjusting for participant characteristics through multivariable linear regression. Results The survey was completed by 718 men. Compared with Gleason 6 out of 10 prostate cancer, the term grade group 1 out of 5 prostate cancer was associated with lower preference for immediate treatment versus active surveillance (β = −9.3; 95% CI, −14.4, −4.2; P < .001), lower diagnosis‐related anxiety (β = −8.3; 95% CI, −12.8, −3.8; P < .001), and lower perceived disease severity (β = −12.3; 95% CI, −16.5, −8.1; P < .001) at the time of initial diagnosis. Differences decreased as participants received more disease‐specific education. Indolent lesion of epithelial origin, a suggested alternative term for indolent tumors, was not associated with differences in anxiety or preference for active surveillance. Conclusions Within a hypothetical clinical scenario, nomenclature for low‐grade prostate cancer affects initial perception of the disease and may alter subsequent decision making, including preference for active surveillance. Disease‐specific education reduces the differential impact of nomenclature use, reaffirming the importance of comprehensive counseling and clear communication between the clinician and patient.

Purpose: Shared decision making is recommended regarding prostate cancer screening. Decision aids may facilitate this process; however, the impact of decision aids on screening preferences is poorly understood. Materials and Methods: In an online survey, a national sample of adults were randomized to one of six different professional societies’ online decision aids. We compared pre- and post-decision aid responses. The primary outcome was change in participant likelihood to undergo or recommend prostate cancer screening on a scale of 1 (unlikely) to 100 (extremely likely). Secondary outcomes included change in participant comfort with prostate cancer screening based on the average of six, five-point Likert-scale questions. Results: Median age was 53 years for the 1,336 participants, and 50% were men. Randomized groups did not differ significantly by race, age, gender, income, marital status, or education level. Likelihood to undergo or recommend prostate cancer screening decreased from 83 to 78 following decision aid exposure (p<0.001; Figure 1a and 1b). Reviewing the decision aid from the Centers for Disease Control or American Academy of Family Physicians did not alter likelihood (both p>0.2), while the decision aid from the United States Preventive Services Task Force was associated with the largest decrease in screening preference (−16.0, p<0.001). Participants reported increased comfort with the decision-making process for prostate cancer screening from 3.5 to 4.1 (out of 5, p<0.001) following exposure to a decision aid. Conclusions: Exposure to a decision aid decreased participant likelihood to undergo or recommend prostate cancer screening and increased comfort with the screening process.

for retention of faculty and has implications for salary parity and job satisfaction. We sought to better understand promotion time lines across gender and race/ethnicity and how academic output impacts promotion.METHODS: We examined data from the 2017 AUA Census. A subset cohort that endorsed having an academic appointment were asked questions regarding their promotion time line. We obtained demographic and academic output information including the number of peer-reviewed articles published and types of grants obtained (NIH, DOD, PCORI, other federal agencies and foundationfunded grants). Complex survey weights were used to make population projections.RESULTS: A total of 554 urologists endorsed having an academic appointment, representing 2,991 urologists in academic medical centers in the United States. Among those 2,991 academic urologists, 12.6% of them are women, 80.3% are white, 6.5% are Hispanic. On average, women took 1.2 years longer than men to advance from Assistant to Associate Professor,7.3 years (95% CI 6.8-7.8) vs 6.1 years, 95% CI 5.7-6.5, p<0.001). Advancement from Associate to Professor was similar in women and men (6.0 years (95% CI 5.1-6.9) vs. 6.4 (95% CI 5.8-7, p<0001). The time line for promotion was not statistically different across race/ethnicity. Women were less likely to be a principal investigator (PI) on a federal grant than men, although this did not reach statistical significance (33.5% (95% CI 24.1-44.4% vs 47.5% (95% CI 42.4-52.6%, p¼0.893).CONCLUSIONS: Women took 1.2 years longer to reach Associate Professor than men, while there was parity in promotion to Professor. Race/ethnicity did not appear to impact the number of years to promotion. Further research is needed to elucidate whether child rearing, gender bias, or other factors are associated with a delay in promotion of women in urology.

Shared decision making is recommended regarding prostate cancer screening. Decision aids may facilitate this process; however, the impact of decision aids on screening preferences is poorly understood. Materials and Methods: In an online survey, a national sample of adults were randomized to one of six different professional societies' online decision aids. We compared pre-and postdecision aid responses. The primary outcome was change in participant likelihood to undergo or recommend prostate cancer screening on a scale of 1 (unlikely) to 100 (extremely likely). Secondary outcomes included change in participant comfort with prostate cancer screening based on the average of six, five-point Likert-scale questions. Results: Median age was 53 years for the 1,336 participants, and 50% were men. Randomized groups did not differ significantly by race, age, gender, income, marital status, or education level. Likelihood to undergo or recommend prostate cancer screening decreased from 83 to 78 following decision aid exposure (p<0.001; Figure 1a and 1b). Reviewing the decision aid from the Centers for Disease Control or American Academy of Family Physicians did not alter likelihood (both p>0.2), while the decision aid from the United States Preventive Services Task Force was associated with the largest decrease in screening preference (−16.0, p<0.001). Participants reported increased comfort with the decision-making process for prostate cancer screening from 3.5 to 4.1 (out of 5, p<0.001) following exposure to a decision aid.