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15th Asia-Pacific Prostate Cancer Conference 2014

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Blog author Dr Sarah Wilkinson enjoys lunchtime entertainment at APCC in Melbourne.

The 15th Asia-Pacific Prostate Cancer Conference 2014 (#apcc14; prostatecancerconference.org.au/) is the largest prostate cancer educational event in the region and attracts over 800 multidisciplinary delegates every year. The world’s leading experts in prostate cancer have featured on the Faculty at this conference in recent year’s and this year’s Faculty was again a great team-sheet for leaders in this field:

The Confernece kicked off on Sun 31st August with a series of Masterclasses including the very popular da Vinci© Prostatectomy Masterclass (featuring Dr Henk Van Der Poel, Dr John Davis, Dr Markus Graefen and Dr Paul Cathcart), along with new master classes focusing on Prostate MRI scanning (led by Dr Jelle Barentsz), and LDR Brachytherapy (led by Dr Juanita Crook).

MRI Prostate Masterclass led by Jelle Barentsz was a sell-out

The Nursing & Allied Health streams also opened their plenary sessions to a busy auditorium. The official Poster and Welcome Session was held on Sunday evening on what was an unseasonally warm and to Winter in Australia. Whilst enjoying the range of lovely canapés and beverages on offer via Melbourne’s premier conference and catering venue (https://mcec.com.au/), delegates caught up with their long lost urology colleagues and perused the high quality posters on display. Poster prizes were awarded for each of the three conference streams; Clinical Urology, Nursing & Allied Health, and Translational Science, as judged by experts in the respective fields. The task of picking just one winner for the Clinical Urology category proved too difficult for judges A/Prof Henry Woo (@DrHWoo) and Dr Phil Dundee (@phildundee), so a dual prize was awarded to both Dr Fairleigh Reeves (@DrFairleighR) and A/Prof Jeremy Millar (@jeremymillar). Rob McDowell took out the poster prize for the Nursing & Allied Health stream with his poster on baseline characteristics of participants in a telephone-delivered mindfulness intervention for men with advanced prostate cancer. The Translational Science winner was Saeid Alinezhad, who presented; ACSM1, CACNA1D and LMNB1 as three novel prostate cancer biomarker candidates.

Monday morning saw the Official Conference Opening given by conference President Prof Tony Costello (@proftcostello) who announced the opening of a new Royal Men’s Hospital to specifically address the needs of men’s health in Australia. The life expectancy of Australian males is currently 5 yrs less than women, and cancer mortality is a third higher for prostate cancer compared to breast. Rates of alcohol, tobacco and drug abuse, as well as suicide, are all 4x higher in men compared to women. 66% Australian men are overweight or obese, and men are also far less likely to visit their GP for a check-up. Next we were lucky enough to have Federal Minister for Health and Sport, the Hon. Peter Dutton MP (@PeterDutton_MP), take leave from Parliament to give the Ministerial Address. Mr Dutton expressed his support for the conference and the forthcoming opening of the new “Royal Men’s Hospital”, a clinic focussed on Men’s Health in Australia’s premier health science precinct, and spoke of how he hopes the recently proposed $20 billion Medical Research Future Fund will further help advances in this area.

Conference President Prof Tony Costello with Australia’s Minister for Health, Hon Peter Dutton MP

The 2nd Patrick C Walsh Lecture was given by Dr Peter Carroll from the Department of Urology, UCSF, USA. Dr Carroll discussed how we can refine current risk assessments for patients with prostate cancer, and in the process give them refined treatment options. Dr Caroll and his team (including Dr Matthew Cooperberg who was also present), have led the way in risk stratification for men with localised prostate cancer and continue to find ways to best select men at higher risk of adverse outcomes.

This year’s point-counter point debate focused on the preferred method of prostate cancer biopsy. In the left side of the ring we had Mr Jeremy Grummet (@jgrummet) who argued the case for a transperineal biopsy due to multi-drug resistant rectal flora. On the right side we had Mr Shomik Sengupta (@shomik_s) who was in favour of sticking with the well-established TRUS. Following a very close audience vote, session chair A/Prof Nathan Lawrentschuk (@lawrentschuk) declared the winner, “Close, but transfecal by an organism.”

The Conference dinner was held on Monday evening at the Mural Hall, Myer Building. 18th century style mirrored commodes and Parisian inspired parquet flooring transported guests to another world, whilst some fine whisky and entertainment was enjoyed.

And for those who hadn’t partied too hard, the Clinical Urology and Translational Science Breakfast sessions were back by popular demand beginning promptly at 6:45 am the next morning. Both sessions focused on genomics and its implications in diagnosis and treatment planning in what is now coined ‘The Genomic Era’.

Later in the morning we remembered renowned British urologist Prof John Fitzpatrick, who sadly passed away aged 65 on May 14th 2014, suffering from a massive subarachnoid haemorrhage. His close colleague and friend, Prof Roger Kirby, delivered the remembrance speech “Life in the Fast Lane”, along with a musically accompanied slide show. Prof Kirby’s tribute can also be read here at Blogs@BJUI (https://www.bjuinternational.com/bjui-blog/professor-john-fitzpatrick-1948-2014/).

The urology Twitterati were again out in full force at #apcc14. During peri-conference period (including the 5 day lead up period, the actual conference dates, and 2 days post-conference), almost 400,000 impressions were generated in cyperspace from 424 tweets, by 111 participants. There was an average of 2 tweets per hr over the peri-conference period and each participant averaged 4 tweets each.

The conference ended with the exciting news of a 2nd Prostate Cancer World Congress, to be held August 18-21st 2015 in beautiful Cairns, Queensland Australia. See you there!

 

 

 

Sarah Wilkinson completed her PhD in prostate cancer research and is now working as a Medical Science Liaison for Oncology and Haematology at GSK. Twitter: @wilko3040

 

Richard Turner-Warwick

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Richard Turner-Warwick CBE MSc, MCh (Oxon), DM.(Oxon), DSc.(Hon NY), FRCP, FRCS, FRCOG, FACS, FRACS (Hon), FACS (Hon)

Richard Turner-Warwick, now retired, but in good health, was one of the giants of British urology and is, quite literally, the Father of reconstructive urology, both nationally and internationally. A brilliant surgeon, teacher and writer, he managed to inspire a great many urologists around the world. He also restored quality of life to countless patients from many continents who had suffered traumatic or neoplastic injury to their genitals or lower urinary tract. In his honour we have organized a meeting on reconstructive urology, kindly supported by The Urology Foundation (TUF), in Glasgow on Saturday 12th October 2014, immediately in advance of the SIU meeting in the same city. This blog is designed to publicise this meeting, and also provide an opportunity for those that worked with and for Richard to post their memories and reminiscences of the great man. Please do post a comment, and also join us in Glasgow at what will certainly be an exceptional day.

LINK TO REGISTER: https://tinyurl.com/RTWmeeting

 

Biography

Born in 1925, Richard Turner-Warwick was educated at Bedales School – at Oxford University and at The Middlesex Hospital Medical School in London. At Oxford he took an honours degree in Natural Science.

He was captain of the Oriel College Boat Club, rowed in the 1944, 1945 Oxford Crews and won the Oxford and Cambridge Boat Race in 1946 when he was President of the OUBC. His MSc thesis was on Neuro-Anatomy.

During his pre-clinical training at The Middlesex Hospital he obtained the Senior Broderip Scholarship and a number of other Medals and Prizes – qualifying in 1949. From 1949 until 1960, mostly at The Middlesex Hospital, he had an unusually extensive specialist training in internal medicine and pathology – and then in abdominal, thoracic, gynecological, and plastic surgery. He trained in urological surgery with Sir Eric Riches and with Sir David Innes Williams at the Institute of Urology in London.

He obtained his FRCS in 1954, his MRCP in 1955, his Oxford Doctorate of Medicine in 1957 and his Oxford Mastership of Surgery in 1962. He was able to visit many urological centres in America as the Comyns Berkley Travelling Fellow – becoming a Senior Resident in Urology at the Columbia-Presbyterian Medical Centre in New York. He was appointed a Consultant General Surgeon to The Middlesex Hospital in 1960 – one of six, with additional charge of the Thyroid Clinic. His outpatient assistant at this time was Deborah Doniach, the pioneer of clinical auto-immunity – her treatment of Hashimoto’s lymphadenoid goitre with thyroxine led to its shrinkage so that decompression-thyroidectomy no longer provided the control histological material she needed – it was for this purpose that he developed his trephine biopsy instrument.

He took over the Urological Department at The Middlesex Hospital when Sir Eric retired in 1963. He created a pioneering urodynamic unit as an integral part of his routine clinical service – synchonously combining video-cysto-urethrography with measurement of pressure and flow voiding dynamics.

Since about 1975 he confined his personal surgical interest and practise to Functional Reconstruction – he was additionally appointed to the staff of St Peter’s Urological Hospitals in London and also an Honorary Visiting Urological Surgeon to the Royal Prince Alfred Hospital in Sydney in 1978 where he operated for three weeks each year until 1987. His main interest and reputation at that time was in reconstruction of the male urethra.

He was elected a Hunterian Professor of the Royal College of Surgeons in 1977, later serving on the Council of this and also that of the Royal College of Obstetricians and Gynaecologists. He was President of the British Association of Urological Surgeons 1982-1984. Among his many distinctions he was given the Victor Bonney prize of the RCOG; in 1987, the Valentine Gold Medal of the New York Academy of Medicine in 1991, the Gordon Watson Medal of the RCS in 1992, the Spence Medal of the American Association of Genito-Urinary Surgeons in 1997 and the William Didusch award of the for medical art in 2002.

He was elected to FACS (Hon). in 1997, to FRACS (Hon) in 1981, to elite Fellowship of the Urological Society of Australia in 1988 the Honorary Fellowship of the American Association of Genito-Urinary Surgeons in 2002. He was awarded an Honorary Doctorate of Science in New York in 1988. During the 40 years between 1965 and 2005 he undertook more than 300 operating surgical teaching visits – mostly in America, Australia, New Zealand but also in Europe and the UK.

 

The Genesis of Urethral Reconstructive Surgery over the Last 50 Years

In Honour of Richard Turner-Warwick

 Friday 10th – Saturday 11th October 2014
Royal College of Physicians and Surgeons, Glasgow

LINK TO REGISTER: https://tinyurl.com/RTWmeeting

 

Friday 10th October

Afternoon      Arrival

19:00             Dinner – with reflections by attendees

Royal College of Surgeons & Physicians, Glasgow

 

Saturday 11th October

09:00             Welcome and Introduction

Christopher Chapple & Roger Kirby

 

09.05              A Lifetime’s Experience of Urethral Surgery

Richard Turner-Warwick

 

09:15              Genesis of Anterior Urethral Surgery: From Scrotum to Oral Mucosa

Jack McAninch

(15 minutes talk, with 5 minutes questions and discussion)

 

09:35              Developments in Bladder Reconstruction

Anthony Stone

(15 minutes talk, with 5 minutes questions and discussion)

 

09:55              Anastomotic Urethroplasty: To Transect The Urethra Or Not? The Heineke Mikulicz Approach

Julian Shah

(15 minutes talk, with 5 minutes questions and discussion)

 

10:15              Oral Mucosa and Beyond

Richard Inman

(15 minutes talk, with 5 minutes questions and discussion)

 

10:35              Effective Management of Lichen Sclerosis

Sanjay Kulkarni

(15 minutes talk, with 5 minutes questions and discussion)

 

10:55              Break for Morning Coffee

 

11:15              Reflections on a Lifetime’s Practice

James Wong

(15 minutes talk, with 5 minutes questions and discussion)

 

11:35              Lessons Learned From the Use of Stents

Christopher Chapple

(15 minutes talk, with 5 minutes questions and discussion)

 

11:55              Penile Surgery

Culley Carson

(15 minutes talk, with 5 minutes questions and discussion)

 

12:15              Hypospadias

Patrick Duffy

(15 minutes talk, with 5 minutes questions and discussion)

 

12:35              Break for Lunch

 

13:30              Difficult Retrieval Surgery

Tony Mundy

(15 minutes talk, with 5 minutes questions and discussion)

 

13:50              Colonic Mucosal Graft Ventral Onlays Utilizing the TEM Transanal Approach

Leonard Zinman

(15 minutes talk, with 5 minutes questions and discussion)

 

14:10              Development of Contemporary Management of Pelvic Fracture Urethral Distraction   Injury

George Webster

(15 minutes talk, with 5 minutes questions and discussion)

 

14:30              Posterior Urethral Reconstruction Following Radical Prostate Surgery: Minimally Invasive Approaches to the Posterior Urethra

Roger Kirby

(15 minutes talk, with 5 minutes questions and discussion)

14:50              Round Table Discussion

All speakers

What do we do well? What don’t we do so well?  What needs to be developed for the future?  Who should carry out surgery?  How should they be trained?  Is there a minimum number of procedures somebody should do per year?  How should we assess outcomes? (45 minutes)

 

15:35              Summary of meeting (10 minutes)

 

15:45              Meeting Closes

 

What’s the diagnosis?

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These images are from a patient who represented with haematuria following conservative management of a grade 4 renal injury.

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Best of China 2014

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Introduction

Recent years have witnessed the boom of Chinese urology. An increasing amount of high-quality research is carried out in China, which is reflected in increasing numbers of articles being accepted by prestigious journals like BJUI. As the president of the Chinese Urological Association, I believe that it is necessary to select provocative articles – focusing on better solutions to widely discussed clinical issues as well as latest achievements from Chinese laboratories – for readers in China and abroad. This BJUI Virtual Issue – Best of China 2014 includes 12 studies from Chinese urologists, covering a wide range from basic research, translational medicine to clinical concerns. Many of the selected studies are aimed to assess the safety and efficacy of a certain urological surgery, such as remote ischaemic preconditioning during laparoscopic partial nephrectomy (by Prof. Yiran Huang), tubeless percutaneous nephrolithotomy (by Prof. Qing Jiang) and photoselective vaporization of the prostate (by Prof. Danfeng Xu), which are hot issues in the clinic. Also, the articles on functional molecules in the progress of urinary disorders (by Prof. Benkang Shi) and urological pathology and epidemiology (by Prof. Liqun Zhou) are well worth reading. I hope that this collection can provide interest and value, and that this Virtual Issue can help to build a solid connection between Chinese urologists and the peers of the world. Many thanks to all of those who contribute to the development of Chinese urology as a cause.

引言

近年来，中国泌尿外科事业发展迅猛，涌现出越来越多高质量的科研成果。在BJUI等权威杂志上中国学者的文章日益增多就是很好的说明。作为CUA的主任委 员，我认为将那些具有启发性的中国泌尿外科学者的文章加以整理，以飨读者是很有意义的。这些文章或是有关临床问题的解决方案，或是有关实验室的最新进展。 这部精选合集就选择了12篇中国泌尿外科学者近期在BJUI发表的文章，内容涵盖基础医学、转化医学和临床医学。有些文章侧重评估当前热议的一些泌尿外科 术式的安全性和有效性，比如肾部分切中远端缺血预处理技术（黄翼然） 、无造瘘管的经皮肾镜术（重医二附院 姜庆）和绿激光前列腺汽化术(徐丹枫)。另外，有关功能性分子在泌尿外科疾病进展中的作用（史本康）及泌尿外科病理学和流行病学的文章（周利群）也值得一 读。我希望这本合集能为读者带来兴趣和启发，希望这本精选集有助于建立中国泌尿外科学者和其他国家的同道之间紧密的联系。感谢那些为中国泌尿外科事业做出 贡献的人们！

Yinghao Sun MD, PhD
President, Second Military Medical University (SMMU)
Director & Professor, Department of Urology, Shanghai Hospital, SMMU
President, Chinese Urological Association (CUA)

Click here for the list of free articles

 

What’s the diagnosis?

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This diagram (modified from Hattori et al.) shows different phases of a multiparametric MRI scan of the prostate.

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Editorial: Neutrophil-to-lymphocyte ratio as a prognostic factor in upper tract urothelial cancer

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The immune system response is critical to cancer development, treatment and progression. Dalpiaz et al. [1]. show that patients with a higher neutrophil-to-lymphocyte ratio (NLR) have a higher cancer-specific and overall mortality when undergoing radical nephroureterectomy for upper tract urothelial cell cancer (UTUC). The study is the first and largest one to evaluate the impact of preoperative NLR on UTUC and proposes its incorporation into our risk assessment tools as an independent predictor of survival.

Pathological prognostic factors such as tumour stage and grade have established importance in UTUC [2]. Additionally, lymphovascular invasion and tumour necrosis have been shown to be independent predictors of survival [3]. Preoperative markers have the advantage of prospective planning and counselling for treatment. The NLR has been studied in various cancers, including renal and gastric, and was recently incorporated into a risk stratification scheme for radical cystectomy patients as an independent prognostic factor for survival [4].

Dalpiaz et al. retrospectively reviewed 202 patients with UTUC who underwent radical nephroureterectomy. A threshold NLR value of 2.7 was used to discriminate between patients. NLR was significantly associated with lymphovascular invasion, but not with age, gender, tumour site, vascular invasion, tumour grade, pathological T-stage, tumour site, tumour location or presence of tumour necrosis. The mean follow-up was 45 months. The median survival was 44.5 months in the low-NLR group and 27 months in the high-NLR group. Multivariate analysis showed that T-stage and NLR were predictors of cancer-specific survival. High NLR and muscle invasion were shown to be independent predictors of overall survival.

Although interesting, these results should be interpreted cautiously as it is very difficult to control all confounders in a retrospective study. The authors did try to address aspects of the inflammatory response by incorporating Eastern Cooperative Oncology Group Performance Status and Charlson Comorbidity Index into their analysis. They found no statistically significant association between NLR and Eastern Cooperative Oncology Group Performance Status or Charlson Comorbidity Index. When adjusting for these variables, the relationships between NLR and cancer-specific survival and between NLR and overall survival were maintained. Although helpful in supporting the conclusions, using the Eastern Cooperative Oncology Group Performance Status and Charlson Comorbidity Index as markers of the inflammatory response should be approached carefully, as many other factors, such as hydronephrosis, tumour invasion, and pre-procedure treatments, which were not evaluated could have a more significant effect on the NLR than general measures of chronic conditions.

The threshold value of the NLR (2.7) was obtained by testing all possible thresholds and choosing a value based on its ability to predict survival and mathematical convenience. Thus the threshold value is self-serving to the conclusion. The statistical analysis suffers due to the dichotomous discrimination as opposed to further divisions like quartiles, but nonetheless shows the value of NLR as an important predictor, the threshold value of which might differ from cohort to cohort.

The present study shows that NLR as an important predictor of survival in UTUC. NLR is easy to perform, relatively inexpensive and is probably already available as part of the standard evaluation of patients with UTUC. It is therefore easy to assess. How should it change our practices? For example, should we be considering neoadjuvant chemotherapy, lymph node dissections or earlier radical surgery in patients with high NLR? The present study develops the hypothesis that can serve as the basis of future validation in a larger cohort or in a prospective fashion.

Read the full article

Moben Mirza
Department of Urology, University of Kansas, Kansas City, KS, USA

References
  2. Rouprêt M, Hupertan V, Seisen T et al.; French National Database on Upper Tract Tumors; Upper Tract Urothelial Carcinoma Collaboration. Prediction of cancer specific survival after radical nephroureterectomy for upper tract urothelial carcinoma: development of an optimized postoperative nomogram using decision curve analysis. J Urol 2013; 189: 1662–1669
  3. Zigeuner R, Shariat SF, Margulis V et al. Tumour necrosis is an indicator of aggressive biology in patients with urothelial carcinoma of the upper urinary tract. Eur Urol 2010; 57: 575
  4. Gondo T, Nakashima J, Ohno Y et al. Prognostic value of neutrophil-to-lymphocyte ratio and establishment of novel preoperative risk stratification model in bladder cancer patients treated with radical cystectomy. Urology 2012; 79: 1085

 

Guideline of Guidelines

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Many of us have developed an addiction to sports this summer. The World Cup football in Brazil with its continuous party spirit, the lush green lawns of Wimbledon and then the Test series between India and England. Our Web Editor could not contain himself:

Amidst all the fun and excitement, three important pieces of news are highlighted here:
  1. I requested our Associate Editor Stacy Loeb, who has a strong background in statistical methodology and health services research, to launch a series entitled ‘Guideline of Guidelines’. Most busy urologists tell me that they often find the many different society guidelines confusing. So we decided to publish a critical summary, finishing up with a set of ‘key points’ that our readers can use in their day-to-day practices. And what better way to kick off than with our biggest controversy – screening for prostate cancer [1].
  1. At #BAUS14 we conducted a live audience poll on when (and if) we should go completely digital. Here are the results:
  1. Inflammatory responses to tumours are recognised as being as important as stage and grade in predicting outcomes of treatment. Our ‘Article of the Month’ is a large 12-year European series of radical surgery for upper tract TCC. Neutrophil–lymphocyte ratio appears to be an important biomarker, as values of >2.7 confer worse cancer-specific and overall survivals [2]. The ratio of total neutrophils:total lymphocytes is easy to calculate from a routine preoperative blood test. I hope that many of you will be able to counsel your patients with this clinically useful biomarker.

Prokar Dasgupta
Editor-in-Chief, BJUI
Guy’s Hospital, King’s College London, London, UK

References

Editorial: The importance of knowing testosterone levels in patients with prostate cancer

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The paper by San Francisco et al. [1] in this issue of BJUI, reviews 154 patients with prostate cancer who were included in an active surveillance cohort. In all, 54 (35%) progressed to active treatment. Men who had disease reclassification had significantly lower free testosterone than those who were not reclassified. They concluded that on multivariate analysis, free testosterone and a family history of prostate cancer were independent predictors of disease reclassification. The authors acknowledge that this was a retrospective study of small size and the data was missing in some of the men, sex hormone-binding globulin (SHBG), luteinizing hormone and oestradiol were not measured. Nevertheless, this review adds to the increasing evidence that it is important to measure testosterone levels in men with prostate cancer.

Previous studies have indicated that a low testosterone level before treatment for prostate cancer is an independent predictor of a more aggressive high-grade cancer [2]. In addition to this, there appears to be an increased likelihood of extraprostatic disease at the time of diagnosis [3] and an unfavourable response to treatment [4].

Garcia-Cruz et al. [5] in 2012 reported that low testosterone bioavailability is related to a positive prostate cancer diagnosis in patients submitted for prostate biopsy. In a further study, he showed that low testosterone levels were related to poor prognosis factors in men with prostate cancer prior to treatment. Testosterone was inversely related to prostate cancer bilaterally and percentage of tumour in the biopsy. Higher testosterone levels were found in patients allocated to the low-risk progression group. In the multivariate analysis, older age and lower testosterone levels were related to a higher D’Amico risk of progression [5]. The researchers went on to show that higher SHBG and lower bioavailable testosterone are related to prostate cancer detection on biopsy. The study was a prospective analysis of 279 patients referred for prostate biopsy. Low bioavailable testosterone and high SHBG levels were related to a 4.9- and 3.2-fold increased risk of detection of prostate cancer on prostate biopsy taken due to an abnormal PSA result or an abnormal DRE [6].

Free testosterone accounts for about 1–2% of total testosterone and hence most circulating testosterone is bound to SHBG and as such, is inactive. Yamamoto et al. [7] had previously shown that men with a low free testosterone (<1.5 ng/dL) had an increased risk of a high Gleason score (>8) compared with men with higher free testosterone (8% vs 2%; P = 0.04). Additionally, a free testosterone level of <1.5 ng/dL was associated with increased risk of biochemical recurrence of tumour.

Morgentaler et al. [8] have been turning conventional wisdom upside down. They report on 13 symptomatic testosterone deficient men who also had untreated prostate cancer. The men received testosterone therapy while undergoing active surveillance for a median of 2.5 years. None of the men had aggressive or advanced prostate cancer and they were rigorously followed up. Despite effective treatment, neither the PSA level nor prostate volume showed any change. Follow-up biopsies were taken in all of the men at yearly intervals and none developed cancer progression.

It is intriguing to think that the decline in testosterone with age and comorbidities may contribute to tumorigenesis in the prostate. Clearly this study needs to be replicated with much larger numbers. But it seems reasonable to suggest that we ought to know about the hormonal environment existing in our patients with prostate cancer. This will of course, raise the even more controversial area of what to do about men with symptomatic hypogonadism with treated and untreated prostate cancer. There is limited data available on this issue.

Before considering testosterone therapy, the first step should be intensive lifestyle intervention; this is not only known to improve cancer survival, but raises total and free testosterone. Weight loss inhibits aromatase, and other complex cytokines, this reduces the suppression of the pituitary gonadal axis and conversion of testosterone to oestrogen, raising testosterone levels.

Read the full article

Michael Kirby*,†
*The Prostate Centre, London, and †Institute of Diabetes for Older People (IDOP), Beds & Herts Postgraduate Medical School, Puckeridge Bury Campus, Luton, UK

References

  1. San Francisco I, Rojas P, Dewolf W, Morgentaler A. Low free testosterone predicts disease reclassification in men with prostate cancer undergoing active surveillance. BJU Int 2014; 114: 229–235
  2. Massengill JC, Sun L, Moul JW et al. Pretreatment total testosterone level predicts pathological stage in patients with localized prostate cancer treated with radical prostatectomy. J Urol 2003; 169: 1670–1675
  3. Chen SS, Chen KK, Lin AT, Chang YH, Wu HH, Chang LS. The correlation between pretreatment serum hormone levels and treatment outcome for patients with prostatic cancer and bony metastasis. BJU Int 2002; 89: 710–713
  4. Ribeiro M, Ruff P, Falkson G. Low serum testosterone and a younger age predict for a poor outcome in metastatic prostate cancer. Am J Clin Oncol 1997; 20: 605–608
  5. Garcia-Cruz E, Piqueras M, Huguet J et al. Low testosterone levels are related to poor prognosis factors in men with prostate cancer prior to treatment. BJU Int 2012; 110: E541–546
  6. Garcia-Cruz E, Carrión Puig A, Garcia-Larrosa A et al. Higher sex hormone-binding globulin and lower bioavailable testosterone. Scand J Urol 2013; 47: 282–289
  7. Yamamoto S, Yonese J, Kawakame S et al. Preoperative serum testosterone level as an independent predictor of treatment failure following radical prostatectomy. Eur Urol 2007; 52: 696–701
  8. Morgentaler A, Liphultz LI, Bennett R, Sweeney M, Avila D Jr, Khera M. Testosterone therapy in men with untreated prostate cancer. J Urol 2011; 185: 1256–1260
Read more articles of the week

What’s the diagnosis?

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Test yourself against our experts with our weekly quiz. You can type your answers here if you want to compare with our answers, or just click the ‘submit’ button below.

Image from Autorino R. et al. BJU Int 2014; 113: 762–768. doi: 10.1111/bju.12455

The patient from the previous quiz is undergoing a procedure.

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SoMe Guidelines in Urology: #urojc August 2014 summary

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The August 2014 twitter-based international urology journal club (#urojc) took an introspective look at the newly published European Association of Urology recommendations on the appropriate use of social media.

This month’s article hit close to home as a panel of international urologists (many who are active on Twitter and #urojc) attempted to bring social media (SoMe) to the general public of urologists with some basic guidelines on effective, safe and honest communication. The article described the various social networks frequently used by physicians, highlighted some benefits of SoMe involvement, and pointed out the possible risks of SoMe. Recommendation statements emphasized clear, confidentiality, refraining from self-promotion, limits on patient-physician interaction and caution in engaging in SoMe.

From the start, it was evident that this was not a fluff piece and there was discussion to be had:

 

@CBayneMD started it off with concern about the recommendation to keep personal and professional content separate. Many argued that adding something personal kept the communication more interesting and reminded readers that behind the online persona is a person.

 

Good arguments were made on both sides. Using different SoMe outlets for personal and professional posts may make it easier to keep it appropriate.

 

The guideline section on refraining from self-promotion was generally well accepted, though some clarification was called for.

 

Another criticism was of the group of EAU panelists chosen to write the guideline. An excellent choice was made to include the twitter handles of the guidelines authors in the byline.

 

Several of the authors are undoubtedly SoMe experts.

 

@wandering_gu, one of the authors, defended the decision to include authors with varied levels of SoMe experience.

A common twitter disclaimer, amongst physicians, “RT (retweets) are not E (endorsements)” may or may not be worth much.

…but may be necessary, nonetheless.

@Dr_RPM summarizes the message of this guideline document.

Whether or not you agree with the EAU SoMe guidelines or the previously published BJUI SoMe Guidelines, it’s clear that SoMe in medicine, and especially urology, is an important part of the future. We should all continue to be thoughtful in our involvement with SoMe and encourage our friends and colleagues to participate. Thank you all for another exciting discussion. Make sure to keep an eye on @iurojc and #urojc for next month’s International Urology Journal Club!

 

Parth K. Modi is a PGY-4 urology resident at Rutgers-RWJMS in New Brunswick, NJ. He has an interest in urologic oncology, robotics and bioethics and tweets @marthpodi.

 

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