Brock O'Neil
· Associate ProfessorUniversity of Utah · Urology
Active 2004–2026
About
Brock O'Neil, MD, is an associate professor in the Division of Urology at the University of Utah School of Medicine and the Huntsman Cancer Institute. His clinical practice focuses on the surgical treatment of genitourinary malignancies, including prostate, bladder, kidney, adrenal, testicular, penile, and urethral cancers. He is an experienced surgeon in robotic, laparoscopic, endoscopic, and open procedures. Dr. O'Neil completed his medical education at the University of Rochester, his residency at the University of Utah, and a fellowship in Urologic Oncology at Vanderbilt University. His work emphasizes providing comprehensive surgical care for urologic cancers, utilizing advanced minimally invasive techniques to improve patient outcomes.
Selected publications
medRxiv · 2026-01-16
articleOpen accessAbstract We previously reported initial results from a clinical trial testing a strategy in which patients with muscle-invasive bladder cancer (MIBC) achieving a clinical complete response after cystoscopic resection of the bladder tumor plus systemic therapy could forgo removal of their entire bladder (cystectomy). While the results were highly promising, a subset of patients omitting initial cystectomy developed recurrence highlighting the need for biomarkers to refine selection of patients for this approach. We here report long-term follow-up of these patients and investigate whether tumor DNA in the plasma (ctDNA) or urine (utDNA) could inform prognosis and the need for cystectomy. Three-year bladder-intact survival among patients with a complete clinical response following four rounds of systemic therapy was 69%. Metastatic risk was significantly higher for patients with detectable versus undetectable ctDNA pre-systemic therapy (HR 4.68; 95% CI 1.10-43.35; log-rank p=0.036). Only 4.5% of patients with undetectable baseline ctDNA developed metastatic disease. Undetectable ctDNA before or after systemic therapy was associated with extremely low metastatic risk. Urine utDNA was more sensitive than plasma ctDNA at detecting residual disease within the bladder, and detectable urine utDNA in patients with a complete clinical response was associated with shorter bladder-intact survival (HR 6.47, 95% CI 1.34-31.31; log-rank p=0.008). These findings establish the conceptual and experimental foundation for incorporating ctDNA and utDNA assays into the management of patients with MIBC, particularly with respect to the need for cystectomy. Significance Statement Radical cystectomy—surgical removal of the bladder and creation of permanent urinary diversion—has historically been used to treat muscle-invasive bladder cancer, but is life-altering with permanent changes to urinary function, sexuality, and daily routine. We show here that systemic therapy, without cystectomy, can lead to durable remission in a subset of patients with muscle-invasive bladder cancer. Furthermore, we show that the measurement of circulating tumor DNA (ctDNA) and urine tumor DNA (utDNA) can identify patients who are most likely to remain cancer-free following this systemic therapy and bladder-preserving approach.
Clinical Genitourinary Cancer · 2026-03-28
articleThe Journal of Rural Health · 2025-03-01 · 1 citations
articleOpen accessBACKGROUND: Rural prostate cancer patients face challenges such as greater distance for cancer treatment and care fragmentation. There have been very few studies investigating adverse health outcomes among prostate cancer survivors residing in rural areas. A comprehensive evaluation of adverse health outcomes among rural prostate cancer patients is needed to understand potential health disparities and provide scientific evidence for interventions. The aims of this study were to investigate prevalent and incident adverse health outcomes among older rural prostate cancer survivors compared to urban prostate cancer survivors in the United States. METHODS: The SEER-Medicare linked database was used to identify first primary prostate cancer survivors. Fine-Gray subdistribution hazard models were utilized to estimate hazard ratios (HR) and 95% confidence intervals (CI), comparing rural prostate cancer patients to urban prostate cancer patients. RESULTS: A total of 37,126 rural prostate cancer survivors and 109,176 urban prostate cancer survivors were identified. We observed that rural prostate cancer survivors had a higher prevalence of rheumatoid arthritis/osteoarthritis (22.1% vs 20.9%; P-value <.001) and chronic obstructive pulmonary disease (COPD)/bronchiectasis (14.2% vs 10.5%; P-value <.001). A higher incident risk of acute myocardial infarction, COPD/bronchiectasis, hip pelvic fracture, and rheumatoid arthritis/osteoarthritis among rural prostate cancer was observed compared to their urban counterparts >5 years after cancer diagnosis. CONCLUSIONS: This study provides important results on the prevalence and incident adverse health outcomes among older rural prostate cancer survivors. Further investigation into how other factors influence these disparities is warranted.
Cancer Medicine · 2025-04-01 · 2 citations
articleOpen accessOBJECTIVE: Rural-urban disparities in cancer care are well documented. However, research on rural-urban disparities regarding patient-reported outcomes (PROs) is still developing. This study analyzed rural-urban disparities in patients with cancer with respect to anxiety, depression, fatigue, pain interference, and physical function. METHODS: This study was conducted at the University of Utah Huntsman Cancer Institute. We integrated data from electronic health records, Cancer Registry, and PRO questionnaires. We assessed the association between rurality status (rural vs. urban) in patients with cancer and PRO scores using multiple linear regression models and t-tests. RESULTS: The cohort included 7271 patients. The mean age was 59.1 years at cancer diagnosis and 48.2% (n = 3505) were female. Across all cancer types, significant differences (Rural vs. Urban) were found for fatigue (53.6 vs. 54.1; p < 0.05) and physical function (45.5 vs. 45.1; p < 0.05). With respect to specific cancer types, there were differences in patients with oral cavity and pharynx cancer for depression (47.9 vs. 50.6; p < 0.01), fatigue (51.6 vs. 54.8; p < 0.05), pain interference (52.8 vs. 55.4; p < 0.05), and physical function (48.0 vs. 44.6; p < 0.01), colorectal cancer for fatigue (56.8 vs. 54.7; p < 0.05), pain interference (56.0 vs. 53.7; p < 0.05), and physical function (42.2 vs. 44.4; p < 0.05), uterus cancer for depression (47.5 vs. 50.5; p < 0.05) and fatigue (51.6 vs. 54.7; p < 0.05), and lung cancer for physical function (37.6 vs. 39.3; p < 0.05). CONCLUSIONS: Across all cancer types, as well as specific cancers, this study found mostly limited rural-urban differences regarding PROs. Except for colorectal and lung/bronchus cancer, patients living in rural areas reported similar or better PRO scores for all cancer types. Results support the hypothesis that improving access can help to level rural-urban disparities regarding cancer care outcomes, because all patients were treated in the same comprehensive cancer center, had similar access to care, and had similar PRO scores.
The Journal of Urology · 2025-04-08
articleClinical Proteomics · 2025-04-18 · 1 citations
articleOpen accessBACKGROUND: Plasma-based high-plex proteomic profiling were performed in prostate cancer (PC) patients using the Olink® Explore Proximity Extension Assay to identify plasma proteins associated in different PC states and to explore potential prognostic biomarkers. The progressive PC states include local, organ-confined PC (local PC), metastatic hormone-sensitive PC (mHSPC) and metastatic castrate-resistant PC (mCRPC). METHODS: Plasma samples were uniformly processed from 84 PC patients (10 patients with local PC; 29 patients with mHSPC; 45 patients with mCRPC). A proteome-wide association study was performed to identify proteins differentially overexpressed in progressive cancer states. Specifically, a sequential screening approach was employed where proteins overexpressed from one disease state were assessed for overexpression in the progressive disease state. Linear regression, analysis of variance, and t-tests were used for this approach. Differentially expressed proteins (DEPs) in mCRPC were then used to construct a prognostic model for overall survival (OS) in mCRPC patients using the Cox Proportional Hazard Model. The predictive performance of this model was assessed using time-dependent area under the receiver operating characteristic curves (tAUC) in an independent sample of mCRPC patients. The tAUC of the prognostic model was then compared to that of a model excluding DEPs to evaluate the added value of circulatory proteins in predicting survival. RESULTS: Of 736 tumor-associated proteins, 26 were differentially expressed across local PC, mHSPC, and mCRPC states. Among these, 20 were overexpressed in metastatic states compared to local, and in mCRPC compared to mHSPC states. Of these 20 proteins, Ribonucleoside-diphosphate reductase subunit M2 (RRM2) was identified as a prognostic biomarker for OS in mCRPC, with a hazard ratio of 2.30 (95% confidence interval (CI) 1.17-4.51) per normalized expression unit increase. The tAUC of the model including previously identified clinical prognostic factors was 0.62 (95% CI 0.29-0.91), whereas the model that includes RRM2 with clinical prognostic factors was 0.87 (95% CI 0.51-0.98). CONCLUSIONS: Plasma proteome profiling can identify novel circulatory DEPs associated with mCRPC state survivals. Overexpression of RRM2 is linked to poor mCRPC survival and its inclusion alongside conventional prognostic factors enhances the predictive performance of the prognostic model.
Journal of Racial and Ethnic Health Disparities · 2025-11-17
articleSenior authorJournal of Clinical Oncology · 2025-05-28
articlee17057 Background: Currently non-specific protein factors (Alkaline Phosphatase-ALK, LDH, albumin) are used for identifying prognostic risk groups in mCRPC. We explored NGS-based proteome sequencing for scalable and high-throughput plasma proteomic profiling for developing an integrated approach of mCRPC tumor-biology associated proteins with existing biomarkers based on patient-centric nomograms that estimate 6-, 12- and 24-months overall survival (OS) probabilities. Methods: Proteomic profiling of plasma for 3,072 proteins using Olink Explore NGS platform was performed in 32 local stage prostate cancer, 123 metastatic hormone-sensitive (mHSPC) and 157 mCRPC state samples (Total N = 312) in a clinically annotated real-world cohort study. Proteins were measured in Normalized Protein eXpression (NPX) units. NPX values of all proteins across all three cancer states were compared to identify Differentially Expressed Proteins (DEPs) exclusively to mCRPC using t-test with multiple corrections. Clinical outcome in the mCRPC was overall survival (OS) and Hazard Ratios (HRs) for mCRPC-DEPs with significant (P<0.05) association with survival at a univariate level were build into an aggregated composite score generated by multiplying each individual DEP’s univariate-level survival HR coefficient with the corresponding NPX value. The “Composite Proteome Prognostic Score (CPPS)” range for the mCRPC cohort (N = 121 pts) was dichotomized above and below the cohort median as “High” and “Low” and evaluated using Cox Proportional Hazard Regression along with current prognostic protein biomarkers (PSA, LDH, Alkaline Phosphatase and Albumin) at the univariate level and included in multi-variable analysis (MVA) for univariate-level significant (P<0.05) variables. Prognostic nomogram integrating MVA significant clinical factors with the CPPS was developed and nomogram performance with and without CPPS for estimating 6-,12- and 24-months survival was determined using Area Under Curve (AUC). Results: Median OS of the mCRPC cohort (N = 157) was 28 months (range: 0.3-45). 866/3072 DEPs were exclusive to mCRPC and 252/866 associated with OS (HR > 1; P < 0.05). 102/252 DEPs were significant after multiple correction (FDR < 0.05). The top 20 DEPs were used to generate CPPS. The CPPS HR value of 3.48 (95% CI: 1.77-6.83) was higher compared to known clinical factors including PSA, LDH , Alkaline Phosphatase, Albumin. AUCs for estimating mCRPC OS probabilities integrating CPPS with clinical factors versus clinical factors alone increased to 0.90 from 0.83 (6-months); 0.86 from 0.72 (12-months) and 0.76 from 0.69 (24-months). Conclusions: A patient-centric nomogram to estimate survival in mCRPC which includes novel protein classifiers can enhance current prognostication models.
Urologic Oncology Seminars and Original Investigations · 2025-03-30
erratumOpen accessSenior authorCorrespondingData Grow in Support of Micro-Ultrasound for Prostate Cancer Diagnosis
The Journal of Urology · 2025-11-14
articleSenior author
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