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Arenas-Gallo C, Michie M, Jones N, Pronovost PJ, Vince RA. Race-Based Screening under the Public Health Ethics Microscope - The Case of Prostate Cancer. N Engl J Med 2024; 391:468-474. [PMID: 39083779 DOI: 10.1056/nejmms2402322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Affiliation(s)
- Camilo Arenas-Gallo
- From the Departments of Bioethics and Medical Humanities (C.A.-G., M.M.) and Urology (C.A.-G., R.A.V.), University Hospitals Cleveland Medical Center, and the University Hospitals Health System, Case Western University School of Medicine (P.J.P.) - both in Cleveland; and the Center for Urban Bioethics, Lewis Katz School of Medicine, Temple University, Philadelphia (N.J.)
| | - Marsha Michie
- From the Departments of Bioethics and Medical Humanities (C.A.-G., M.M.) and Urology (C.A.-G., R.A.V.), University Hospitals Cleveland Medical Center, and the University Hospitals Health System, Case Western University School of Medicine (P.J.P.) - both in Cleveland; and the Center for Urban Bioethics, Lewis Katz School of Medicine, Temple University, Philadelphia (N.J.)
| | - Nora Jones
- From the Departments of Bioethics and Medical Humanities (C.A.-G., M.M.) and Urology (C.A.-G., R.A.V.), University Hospitals Cleveland Medical Center, and the University Hospitals Health System, Case Western University School of Medicine (P.J.P.) - both in Cleveland; and the Center for Urban Bioethics, Lewis Katz School of Medicine, Temple University, Philadelphia (N.J.)
| | - Peter J Pronovost
- From the Departments of Bioethics and Medical Humanities (C.A.-G., M.M.) and Urology (C.A.-G., R.A.V.), University Hospitals Cleveland Medical Center, and the University Hospitals Health System, Case Western University School of Medicine (P.J.P.) - both in Cleveland; and the Center for Urban Bioethics, Lewis Katz School of Medicine, Temple University, Philadelphia (N.J.)
| | - Randy A Vince
- From the Departments of Bioethics and Medical Humanities (C.A.-G., M.M.) and Urology (C.A.-G., R.A.V.), University Hospitals Cleveland Medical Center, and the University Hospitals Health System, Case Western University School of Medicine (P.J.P.) - both in Cleveland; and the Center for Urban Bioethics, Lewis Katz School of Medicine, Temple University, Philadelphia (N.J.)
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2
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Lillard JW, Moses KA, Mahal BA, George DJ. Racial disparities in Black men with prostate cancer: A literature review. Cancer 2022; 128:3787-3795. [PMID: 36066378 PMCID: PMC9826514 DOI: 10.1002/cncr.34433] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 01/11/2023]
Abstract
Black men are disproportionately affected by prostate cancer (PCa), with earlier presentation, more aggressive disease, and higher mortality rates versus White men. Furthermore, Black men have less access to PCa treatment and experience longer delays between diagnosis and treatment. In this review, the authors discuss the factors contributing to racial disparities and present solutions to improve access to care and increase clinical trial participation among Black men with PCa. Racial disparities observed among Black men with PCa are multifaceted, evolving from institutional racism. Cultural factors include generalized mistrust of the health care system, poor physician-patient communication, lack of information on PCa and treatment options, fear of PCa diagnosis, and perceived societal stigma of the disease. In the United States, geographic trends in racial disparities have been observed. Economic factors, e.g., cost of care, recovery time, and cancer debt, play an important role in racial disparities observed in PCa treatment and outcomes. Racial diversity is often lacking in genomic and precision medicine studies. Black men are largely underrepresented in key phase 3 PCa trials and may be less willing to enroll in clinical trials due to lack of awareness, lack of diversity in clinical trial research teams, and bias of health care providers to recommend clinical research. The authors propose solutions to address these factors that include educating clinicians and institutions on the barriers Black men experience, increasing the diversity of health care providers and clinical research teams, and empowering Black men to be involved in their treatment, which are keys to creating equity for Black men with PCa. LAY SUMMARY: Prostate cancer negatively affects Black men more than men of other races. The history of segregation and mistreatment in the health care system may contribute to mistrust among Black men. Outcomes are worse for Black men because they are less likely to be screened or to receive treatment for prostate cancer. Black men also are unlikely to participate in clinical research, making it difficult for investigators to understand how Black men are affected by prostate cancer. Suggestions for addressing these differences include teaching physicians and nurses about the issues Black men experience getting treatment and improving how Black men get information on prostate cancer.
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Affiliation(s)
- James W. Lillard
- Department of MicrobiologyBiochemistry, and Immunology, Morehouse School of MedicineAtlantaGeorgiaUSA
| | - Kelvin A. Moses
- Department of UrologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Brandon A. Mahal
- Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Daniel J. George
- Duke Cancer InstituteUniversity School of MedicineDurhamNorth CarolinaUSA
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3
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Zimmerman R, Bilen MA, Heath EI, Nandagopal L, Swami U, Kessel A, Jaeger E, Wesolowski S, Hernanadez EJ, Chipman J, Mack A, Ravindranathan D, Maughan BL, Nussenzveig R, Yandell M, Kohli M, Lilly MB, Sartor AO, Agarwal N, Barata PC. Comprehensive Genomic Profiling of Cell-Free DNA in Men With Advanced Prostate Cancer: Differences in Genomic Landscape Based on Race. Oncologist 2022; 27:e815-e818. [PMID: 36036607 PMCID: PMC9526493 DOI: 10.1093/oncolo/oyac176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/11/2022] [Indexed: 11/26/2022] Open
Abstract
Advanced prostate cancer (aPC) in Black men was reported to present with aggressive features and to be associated with poor prognosis. Herein, we compared the cell-free DNA (cfDNA) genomic landscape of aPC in Black vs White men. Patients (pts) with aPC from 6 academic institutions and available cfDNA comprehensive genomic profiling (CGP) were included. Association between mutated genes and race was evaluated using Barnard’s test and a Probabilistic Graphical Model (PGM) machine learning approach. Analysis included 743 aPC pts (217 Black, 526 White) with available cfDNA CGP. The frequency of alterations in the androgen receptor gene was significantly higher in Black vs White men (55.3% vs 35% respectively, P < .001). Additionally, alterations in EGFR, MYC, FGFR1, and CTNNB1 were present at higher frequencies in Black men. PGM analysis and Barnard’s test were concordant. Findings from the largest cohort of Black men with aPC undergoing cfDNA CGP may guide further drug development in these men.
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Affiliation(s)
- Raquel Zimmerman
- University of Utah School of Medicine, Salt Lake City, UT, USA.,Department of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | - Mehmet A Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Elisabeth I Heath
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Umang Swami
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Adam Kessel
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Ellen Jaeger
- Deming Department of Medicine, Section of Hematology/Oncology, Tulane University Medical School, New Orleans, LA, USA
| | | | - Edgar J Hernanadez
- Department of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | | | - Alleda Mack
- Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Deepak Ravindranathan
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Mark Yandell
- Department of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | - Manish Kohli
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Michael B Lilly
- Medical University of South Carolina Hollings Cancer Center, Charleston, SC, USA
| | - A Oliver Sartor
- Deming Department of Medicine, Section of Hematology/Oncology, Tulane University Medical School, New Orleans, LA, USA
| | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Pedro C Barata
- Deming Department of Medicine, Section of Hematology/Oncology, Tulane University Medical School, New Orleans, LA, USA
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Arenas-Gallo C, Owiredu J, Weinstein I, Lewicki P, Basourakos SP, Vince R, Al Hussein Al Awamlh B, Schumacher FR, Spratt DE, Barbieri CE, Shoag JE. Race and prostate cancer: genomic landscape. Nat Rev Urol 2022; 19:547-561. [PMID: 35945369 DOI: 10.1038/s41585-022-00622-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 11/09/2022]
Abstract
In the past 20 years, new insights into the genomic pathogenesis of prostate cancer have been provided. Large-scale integrative genomics approaches enabled researchers to characterize the genetic and epigenetic landscape of prostate cancer and to define different molecular subclasses based on the combination of genetic alterations, gene expression patterns and methylation profiles. Several molecular drivers of prostate cancer have been identified, some of which are different in men of different races. However, the extent to which genomics can explain racial disparities in prostate cancer outcomes is unclear. Future collaborative genomic studies overcoming the underrepresentation of non-white patients and other minority populations are essential.
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Affiliation(s)
- Camilo Arenas-Gallo
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jude Owiredu
- Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Ilon Weinstein
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Patrick Lewicki
- Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Spyridon P Basourakos
- Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Randy Vince
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Bashir Al Hussein Al Awamlh
- Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.,Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Fredrick R Schumacher
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Daniel E Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Christopher E Barbieri
- Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Jonathan E Shoag
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA. .,Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA. .,Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA.
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5
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Swami N, Yamoah K, Mahal BA, Dee EC. The right to be screened: Identifying and addressing inequities in genetic screening. LANCET REGIONAL HEALTH. AMERICAS 2022; 11:100251. [PMID: 36778922 PMCID: PMC9903822 DOI: 10.1016/j.lana.2022.100251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Nishwant Swami
- University of Massachusetts Medical School, Worcester, MA, USA,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kosj Yamoah
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, University of South Florida, Tampa, FL, USA
| | - Brandon A. Mahal
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA,Corresponding author.
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Kamran SC, Xie J, Cheung ATM, Mavura MY, Song H, Palapattu EL, Madej J, Gusev A, Van Allen EM, Huang FW. Tumor Mutations Across Racial Groups in a Real-World Data Registry. JCO Precis Oncol 2022; 5:1654-1658. [PMID: 34994651 DOI: 10.1200/po.21.00340] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sophia C Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.,Broad Institute of Harvard and MIT, Cambridge, MA
| | - Jamie Xie
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Alexander T M Cheung
- Dana-Farber Cancer Institute, Boston, MA.,Broad Institute of Harvard and MIT, Cambridge, MA.,Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, MA.,NYU Grossman School of Medicine, New York, NY
| | - Mnaya Y Mavura
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.,Institute for Human Genetics, University of California, San Francisco, San Francisco, CA
| | - Hanbing Song
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Elina L Palapattu
- Dana-Farber Cancer Institute, Boston, MA.,Broad Institute of Harvard and MIT, Cambridge, MA.,Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, MA
| | - Joanna Madej
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Alexander Gusev
- Department of Medical Oncology, Dana-Farber Cancer Institute & Harvard Medical School, Boston, MA
| | - Eliezer M Van Allen
- Dana-Farber Cancer Institute, Boston, MA.,Broad Institute of Harvard and MIT, Cambridge, MA.,Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, MA
| | - Franklin W Huang
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA
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Schumacher FR, Basourakos SP, Lewicki PJ, Vince R, Spratt DE, Barbieri CE, Shoag JE. Race and Genetic Alterations in Prostate Cancer. JCO Precis Oncol 2021; 5:PO.21.00324. [PMID: 34746633 PMCID: PMC8563071 DOI: 10.1200/po.21.00324] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 09/06/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Fredrick R. Schumacher
- Fredrick R. Schumacher, PhD, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH; Spyridon P. Basourakos, MD, and Patrick J. Lewicki, MD, Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY; Randy Vince, MD, Department of Urology, University of Michigan, Ann Arbor, MI; Daniel E. Spratt, MD, Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; Christopher E. Barbieri, MD, PhD, Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY; and Jonathan E. Shoag, MD, Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Spyridon P. Basourakos
- Fredrick R. Schumacher, PhD, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH; Spyridon P. Basourakos, MD, and Patrick J. Lewicki, MD, Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY; Randy Vince, MD, Department of Urology, University of Michigan, Ann Arbor, MI; Daniel E. Spratt, MD, Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; Christopher E. Barbieri, MD, PhD, Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY; and Jonathan E. Shoag, MD, Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Patrick J. Lewicki
- Fredrick R. Schumacher, PhD, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH; Spyridon P. Basourakos, MD, and Patrick J. Lewicki, MD, Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY; Randy Vince, MD, Department of Urology, University of Michigan, Ann Arbor, MI; Daniel E. Spratt, MD, Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; Christopher E. Barbieri, MD, PhD, Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY; and Jonathan E. Shoag, MD, Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Randy Vince
- Fredrick R. Schumacher, PhD, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH; Spyridon P. Basourakos, MD, and Patrick J. Lewicki, MD, Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY; Randy Vince, MD, Department of Urology, University of Michigan, Ann Arbor, MI; Daniel E. Spratt, MD, Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; Christopher E. Barbieri, MD, PhD, Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY; and Jonathan E. Shoag, MD, Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Daniel E. Spratt
- Fredrick R. Schumacher, PhD, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH; Spyridon P. Basourakos, MD, and Patrick J. Lewicki, MD, Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY; Randy Vince, MD, Department of Urology, University of Michigan, Ann Arbor, MI; Daniel E. Spratt, MD, Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; Christopher E. Barbieri, MD, PhD, Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY; and Jonathan E. Shoag, MD, Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Christopher E. Barbieri
- Fredrick R. Schumacher, PhD, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH; Spyridon P. Basourakos, MD, and Patrick J. Lewicki, MD, Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY; Randy Vince, MD, Department of Urology, University of Michigan, Ann Arbor, MI; Daniel E. Spratt, MD, Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; Christopher E. Barbieri, MD, PhD, Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY; and Jonathan E. Shoag, MD, Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Jonathan E. Shoag
- Fredrick R. Schumacher, PhD, Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH; Spyridon P. Basourakos, MD, and Patrick J. Lewicki, MD, Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY; Randy Vince, MD, Department of Urology, University of Michigan, Ann Arbor, MI; Daniel E. Spratt, MD, Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH; Christopher E. Barbieri, MD, PhD, Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY; and Jonathan E. Shoag, MD, Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
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