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Recidivism in Patients with Advanced vs. Localized Prostate Cancer: Elucidating Causes to Reduce Emergency Room Burden
William Connolly, BA, MSF1, Alexandra Lee, BS
1, Owen Charles Phelps, BS
2, Shriya Perati, BS
1, Javier Prieto, BS
1, Angelo Blancafor, BS
1, Leah McDonald, MD
3, Elias Hyams, MD
3.
1Brown University, Providence, RI, USA,
2Mercer University, Macon, GA, USA,
3Brown University Health, Providence, RI, USA.
BACKGROUND: Emergency department (ED) presentations among prostate cancer (PCa) patients are common, occurring in 15-25% patients, with higher rates among advanced disease patients. ED visit causes are often related to treatment complications or disease progression. Evidence is limited regarding causes for ED presentation among PCa patients and diagnoses associated with repeated presentations (recidivism), especially discerning localized and advanced disease. METHODS: This retrospective study examines patients with PCa with ED visits between 2020-2024. An initial sample of 691 patients was screened, and recidivism was defined as >2 ED visits after diagnosis. Recidivist patients were divided into localized vs. advanced disease, then analyzed based on treatment type, presenting diagnosis, and disposition. RESULTS: 180 patients with PCa were identified as ED recidivists. Of the 129 localized disease recidivist patients, 32 were treated with surgery (28.1%), 50 with radiation (RT) (43.9%), 7 with androgen deprivation therapy (ADT) (6.1%), and 25 with RT+ADT (21.9%). Among 51 advanced disease patients, only 1 patient was treated surgically (2.0%), 2 with RT (4.0%), 18 with hormone therapy (36.0%), and 29 with combination therapy (58.0%). For localized disease recidivist patients, most diagnoses related to gross hematuria (GH) (43.2%) and acute kidney failure (24.8%). For advanced disease recidivist patients, presenting diagnoses were GH (49%), and urinary retention (19.6%). 40% of recidivist patients with localized disease were admitted, while only 25.5% of advanced disease patients were admitted. CONCLUSIONS: These findings highlight significant aspects of ED recidivism in both localized and advanced PCa. For both groups, GH is a common source of morbidity causing ED presentation. Urinary retention is more common in advanced patients as a recurrent issue. Care coordination and access to outpatient systems are critical to limit recidivism. Lack of admission of many patients, regardless of cause, suggests ED presentations could be reduced with improved knowledge and optimized follow-up care.
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