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15th Asia-Pacific Prostate Cancer Conference 2014

September 15, 2014/by Sarah Wilkinson

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

The 15^th 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 31^st 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 2^nd 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. 18^th 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 14^th 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 2^nd Prostate Cancer World Congress, to be held August 18-21^st 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

Canadian Urological Association 69th Annual Meeting on the Rock

July 10, 2014/1 Comment/by Ellen Forbes

June 27 to July 1, 2014 saw close to 900 Canadian urologists & associates come together in the country’s most easterly city – St John’s, Newfoundland – for the 69^th annual Canadian Urological Association meeting (https://www.cua.org/). As ‘Newfies’ have a well-established reputation in our country for their extreme friendliness, unique traditions and ability to throw one hell of a party, it was a highly anticipated four days!

The meeting kicked off on Friday with various pre-CUA affiliated meetings, such as the Executive Committee Meeting, CAGMO and CUOG meetings. An optional Advanced Laparoscopic and Robotic Urology Skills Course was held over two days on Thursday & Friday. Also on Friday, the incoming final-year residents from across Canada began the annual senior resident retreat (CSUR), which included excellent sessions with Dr Gerald Brock on resident involvement with the CUA and Dr Robert Siemens on critically reviewing the literature. We residents were also lucky enough to be invited to enjoy a lobster dinner and beer tasting at YellowBelly Brewery & Public House – one of the oldest structures in North America dating back to 1725. Sitting at the intersection of Water St & George St, this impressive stone gastropub is the location where the ‘Great Fire of 1892’ was finally extinguished. The evening, for most, carried on to George St – the street with the most bars & pubs per square foot of any street in North America!

The CSUR course finished on Saturday after a great half-day review of urodynamics with Drs Greg Bailly and Jerzy Gajewski. Further affiliated meetings were held including the 2^nd CUA Multidisciplinary Meeting for members of CAGMO, CUOG, GUROC and CNUP. An instructional course entitled Better Botox – from patient prep to injection protocols, was also offered to attendees. The major part of the CUA meeting (https://cuameeting.org/index.php/en/) began officially on Saturday afternoon with the first two Educational Forums – both on the topic of Castrate Resistant Prostate Cancer with tips and tools for the Canadian urologist to improve care of patients with CRPC. This included presentations from Drs Neil Fleshner, Ricardo Rendon, Alan So, Lorne Aaron, and Geoff Gotto. Here it was stressed that urologists should be comfortable as the primary physician giving medical treatment for CRPC. Saturday evening held the conference welcome reception – always a fantastic reunion – and unmoderated poster session.

Sunday morning started with a Welcome Address from CUA President Dr Peter Anderson, followed by the first State-of-the-Art Lecture on the role of medical management of nephrolithiasis in the age of lithotripsy with a focus on AUA Guidelines – an excellent overview presented by Dr Glenn Preminger of Durham, NC. A similarly themed Educational Forum covering medical management of stones in a case-based approach followed this; faculty included Dr Preminger as well as Drs Sero Andonian, John Dushinski and Jason Lee. The second State-of-the-Art Lecture saw Dr Surena Matin from Houston, TX present on neoadjuvant chemotherapy for UTUC, where he discussed benefits such as taking advantage of pre-op renal function and results showing both down-staging and a survival advantage. An Educational Forum followed on strategies for upper tract surveillance in urothelial carcinoma, management of post-op urinary diversion complications and contemporary use of biomarkers by Drs Matin, Adrian Fairey and Alan So. In the afternoon, Dr Eric Rovner from Charleston, SC gave a State-of-the-Art Lecture on SUI and slings. He presented an algorithm using the best available evidence on appropriate selection of sling type and reiterated that urodynamic studies are not necessary pre-operatively in the ideal index SUI patient. A forum entitled ‘Innovations in Functional Urology’ had Dr Catherine Dubeau from Worcester, MA joining Drs Sender Herschorn and Eric Rovner to discuss female SUI, post-prostatectomy incontinence and management of elderly patients with OAB. Dr William Gee from Lexington, KY then gave the address of the AUA President-elect, which was followed by the CUASF lecture by Dr Ron Kodama who discussed education & evaluation of residents. The late afternoon took a pediatric turn including a lecture by Dr Anthony Caldamone from Providence, RI on ‘Putting the Undescended Testicle in its Place!’ A point/counterpoint followed between Dr Caldamone and Dr Martin Koyle on the ideal surgical management for congenital duplication anomalies. The day wrapped up with podium sessions on pediatric urology, endourology and surgical education.

The annual CUA ‘fun night’ took place Sunday evening and was entitled Rally in the Alley. This was a very well-organized pub crawl that saw roughly 500 people split into 5 groups, each with a signature scarf colour and a different instrument to follow. For example, if you were in the blue bagpipe group, you put on your blue scarf and followed the bagpiper who would lead from pub to pub on George St (https://www.georgestreetlive.ca/). With one minute left before switching locations, you’d hear the bagpiper start up again – the signal to down your drink and move on! The five groups each did the pubs in a different order so that there was no overlap until everyone convened at the same final destination. In addition, each pub had a very ‘Newfie’ activity for everyone to try – including Irish Dancing, singing Newfie songs (‘we’ll rant and we’ll roar like true Newfoundlanders!’), and of course getting ‘Screeched in’ – a Newfoundland tradition involving reciting a poem, downing a shot of the cheap high alcohol spirit and kissing a freshly caught cod! It was an awesome night that truly gave all the ‘come from away’ folks a glimpse of life in Newfoundland (and perhaps a hangover to boot).

Monday was another full day, starting with moderated poster sessions on prostate cancer, pediatrics and sexual health and infertility. Next, Drs Paul Johnston and Stephen Steele gave a brief overview of clinical pearls that could change your practice. A State-of-the-Art Lecture by Dr Daniel Lin from Seattle, WA followed; he discussed selection of patients and outcomes in active surveillance. An Educational Forum came after this with Drs Laurence Klotz, Daniel Lin, and Chris Morash covering prostate biopsy and active surveillance.

The afternoon kicked off with the EAU Address from Dr Andrzej Borkowski of Warsaw, Polland, followed by a State-of-the-Art Lecture from Dr Mark Speakman of Somerset, UK on LUTS/BPH. Dr Speakman’s lecture was both highly entertaining and informative, and he stressed the importance of exercise and a healthy lifestyle in preventing LUTS progression. Drs Speakman, Gerald Brock, Sender Herschorn, and David Staskin of Boston, MA then gave an educational forum on prevention and management of LUTS/BPH. Dr Laurence Levine then discussed treatment of Peyronie’s Disease in the seventh State-of-the-Art Lecture, giving a useful summary on which type of surgery to choose depending on patient factors such as penile length and erectile function. An Educational Forum finished off the afternoon and covered the often-dreaded topic of Management of Scrotal Pain. Drs Keith Jarvi, Jay Lee, and Laurence Levine emphasized the importance of a multi-disciplinary approach in dealing with this type of chronic pain, and created a systematic approach that most urologists could utilize to avoid feeling helpless in dealing with this disorder. Dr Levine also showed promising results of micro-denervation of the spermatic cord for patients with refractory scrotal pain and good response to a cord block.

Monday evening held the annual President’s Reception. At the back of the room was a bar made entirely from carved ice – proving that Newfies really do love their icebergs. You can even drink beer made using 25,000-year-old iceberg water harvested from a Newfoundland ‘berg! These huge ice formations can be seen, along with whales, from the very picturesque, well-worth-the-climb, Signal Hill in St John’s. The reception also saw Dr Peter Anderson present Dr Jerzy Gajewski with the CUA Lifetime Achievement Award; clearly a surprise to Dr Gajewski but a well-deserved honour. Dr Anderson then handed over the reigns as CUA president to Dr Stuart Oake, who gave a sneak preview of what to expect in Ottawa for the annual meeting in June of 2015.

The final day of the conference started with a smorgasbord of topics in six different moderated poster sessions. Drs Bobby Shayegan and Keith Rourke covered ‘clinical pearls that could change your practice’ – a collection of useful tidbits collected during the various lectures and forums throughout the 4-day conference. Dr Derek Puddester gave a State-of-the-Art Lecture on physician health & wellness, reminding us all to practice mindfulness often. The final State-of-the-Art Lecture was by Dr Axel Heidenreich from Aachen, Germany, who covered the role of radial prostatectomy in the management of locally advance and metastatic prostate cancer. The last educational forum was on optimizing patient outcomes in kidney cancer – a session given by Drs Heidenreich, Rodney Breau, Steven Pauler and Simon Tanguay.

As the conference came to a close, staff and residents from across the country sat in the St John’s airport and reminisced about the week’s events. It was not only a great educational opportunity that many took advantage of; it was also a relaxing reunion for the relatively small group of urologists that are spread out across this vast country. Kudos to Dr Anderson and the Local Organizing Committee lead by Chair Dr Chris French, for putting on a meeting to remember. Newfoundland is certainly a beautiful and unique corner of our great country, and anyone would be wise to pay ‘the Rock’ a visit (https://www.newfoundlandlabrador.com/). Finally, if there is anywhere better to spend Canada Day than the charming easterly city of St John’s Newfoundland, it’s Ottawa, Ontario. So mark your calendars, as everyone is invited to the CUA meeting in Ottawa, June 27-30 2015! See you there!

Ellen Forbes is a Urology Resident at the University of Alberta. Twitter: @DrElForbes

Best bits of BAUS 2014

July 2, 2014/by Archana Fernando

By Archie Fernando

As the friendliest taxi driver in the world dropped me off outside the vast BT centre in Liverpool he asked “if you’re all in there, what’s going to happen to the rest of us?” I wasn’t sure whether he was envisaging an epidemic of priapism, but I reckoned we’d be ok for a few days.

Inside the specious and well-designed conference centre (below) there was an overwhelmingly positive vibe as old friends caught up, new acquaintances were made and a packed scientific program rolled out.

Of course there was really too much to be able to capture all the highlights but here are some of the headlines.

BOO women?

Chris Harding highlighted that female bladder outlet obstruction (BOO) is more common than we think and Tamsin Greenwell talked about the management of female urethral strictures.

Question time

Several MDTs /case studies tested the application of theory to clinical practice. Online, real time voting increased audience interaction and interest.

Taking control of the men

Urologists need to feature more prominently in infertility clinics. It appears that couples are being pushed towards donor sperm prior to discussing their options with a urologist.

Can you find it?

Increasing problems with obesity and the penis – ED, buried penis, sexual dysfunction, and phimosis. Metabolic syndrome and psychological unrest are highly prevalent in this population and should be addressed alongside the andrology. (See the BJUI free Virtual Issue for more on obesity in urology).

Two birds, one stone

ED and LUTS often co-exist to a degree in men of a certain age. Tadalafil has now been licensed for the treatment of both.

On the shoulders of giants…

Mark Soloway gave a fantastic talk in the Perspectives of Oncology session that had a very original Beatles theme this year. He reflected on his career and paid homage to many of the people who have contributed to the modern management of bladder cancer, without whom we wouldn’t have BCG, cisplatin, mitomycin, fibreoptics….

The surgeon is the most important factor

Shahrokh Shariat drove home that there is no salvage therapy for poor surgery in muscle-invasive bladder cancer. Brausi et al. have shown that the surgeon is the most important factor in non-muscle invasive bladder cancer and this was also re-enforced throughout the bladder cancer sessions.

Sniffing out bladder cancer

Chris Pobert introduced the Odoreader™. It all began with the discovery that dogs could sniff out melanoma, and subsequently TCC! The Odoreader™ uses a small sample of urine to produce a trace that represents the composition of gas detected by the sensor. The trace produced by patients with bladder cancer is different to those without. It has an accuracy of approximately 96%. Will surveillance cystoscopy become a thing of the past?

Look up

The location of upper tract TCC does not appear to influence outcomes but tumours in the renal pelvis are picked up later than ureteric tumours. Distal ureterectomy is becoming a popular and safe alternative to nephro-ureterectomy in selected patients.

No stone left unturned

Metabolic work up for stones should ideally include serum chemistry, stone analysis and 24-hour urine. A third of 24-hour urine samples show variability and so two samples upfront with a possible 3^rd prior to intervention increases the accuracy of the test.

Tailored metabolic advice for stone formers can reduce recurrence rates by up to 60%.

What’s in a stone?

Sri Sriprasad looked at new insights into stone aetiology. Calcium oxalate monohydrate is oxalate dependent whereas calcium oxalate dihydrate tends to be calcium dependent. Metabolic advice should include lowering phosphorous intake from soft drinks, weight loss, reduced salt and protein, and maintaining a urine output of >2.5 L/day.

Is tamsulosin the new ‘vitamin C’ in stone disease?

There are more alpha-receptors in the obstructed kidney. It appears that tamsulosin is not only effective in increasing the rates of spontaneous stone passage, but also in increasing stone passage rates following laser fragmentation and shock-wave lithotripsy. Get prescribing.

Size matters

Steve Nakada suggested that we should be measuring stone volume rather than diameter to provide a more accurate measure of stone size and guide management.

How small can you go?

Martin Schonthaler talked about the evolution of the ultra-mini PCNL. Mini-, ultra-mini and micro PCNL work and are safe. The question now is when should we be using these techniques?

You can’t fight your genes

David Neal gave The Urology Foundation guest lecture on ‘The Genomic Landscape of Prostate Cancer’.

“Cancer is a disease of genomic chaos”. He had a very interesting perspective on focal therapy – if prostate cancer is in your genes, will targeting the single focus of prostate cancer cure you or simply buy time until the rest of the prostate starts to turn malignant?

Is prostate MRI the next Franz Gsellmann world machine?

Gsellmann is an Austrian farmer who over 23 years built a machine made up of hundreds of different parts including a ship’s propeller, two gondolas and 25 motors. When powered up it becomes a spectacle of colour, sound and light but doesn’t actually do anything. Karl Pummer compared MRI of prostate to the world machine –pretty but useless! He argued that the sensitivity of prostate cancer varies hugely from 30-90% and only 31 of the 4687 references matching ‘prostate cancer imaging’ met sufficient criteria to be considered for the German prostate cancer guideline.

Six prostates a day keeps the cancer away

Jay Smith does six prostatectomies in a day. Is this the level all surgeons should be striving for or is it the start of a slippery slope to replacing clinician with technician? Whatever your view, you have to admit it’s pretty impressive!

Has the robotic train left the station?

Striking at the source

David Neal suggested that there may be a role for prostatectomy in the context of metastatic prostate cancer because the primary may continue to drive the disease.

Biopsy or not to biopsy?

No, this is not about prostate biopsy! Benign histology remains a challenge in the management of the small renal mass. As biopsy and pathological techniques improve should we be doing more biopsies to help guide decision-making? Steve Nakada certainly made a convincing case for this, which was hotly debated on twitter.

Freeze!

Small renal masses have a good prognosis overall therefore minimizing morbidity should be a priority. Ablative techniques have been shown to be safe technically and oncologically in selected cases.

“Uncontrolled variability is the enemy of progress”

John McGrath used the enhanced recovery program as an example of the enormous variability in practice across UK centres that cannot be explained by case mix alone. This makes it difficult to deliver consistent service and training. We need to develop protocols that allow us all to sing from the same hymn sheet.

E-Z-learning

Henry Woo introduced an exciting new CME platform, BJUI Knowledge, in the BJUI International Guest lecture. He also explained that at present there is a gap between user expectations of e-learning (any time, anywhere, any device) and what it can deliver. Follow @BJUIknowledge on Twitter for updates.

Private training

How are trainees going to get experience with operations such as vasectomy reversal and microsurgery that are not available on the NHS?

Changing of the guard

After four years of dedicated service to BAUS, Adrian Joyce hands over the baton (aka large shiny necklace) to Mark Speakman. We wish them both the best of luck.

Tweet tweet

Being a very new addition to the uro-twitterati I was a little sceptical about how twitter would enhance a meeting like BAUS. However, I was impressed by the content and activity that goes on. Congratulations to BAUS for adding twitter screens this year, which kept everyone entertained and up-to-date creating a community feel. I’m definitely a convert!

And the stats agree with me. #BAUS14 analytics at time of posting: 268 participants; 1,363 tweets with 1,209,617 digital impressions. This is a stark improvement on #BAUS13 which attracted only 90 participants with 564 tweets, and one that will surely continue. Tweet away folks!

Until next time

What a fantastic meeting this year with the almost perfect mix of basic science, clinical research, and expert perspectives, topped off with a smidgen of nocturnal merriment. The best of British urology.

I was feeling a little low in energy as I left the Albert Dock on the final day until I got this text – same again next summer? 🙂

Hope to see you all in Manchester!

Archana Fernando is a urologist at Guy’s Hospital, London. Follow her on Twitter @fernando_archie

5 Questions with Per-Anders Abrahamsson and Gopal Badlani

June 23, 2014/by John Davis

Secretary Generals to the big Spring Meetings, European Association of Urology and the American Urological Association

Every Spring, thousands of urologists gather in big cities with mega-venues to attend one or both of the annual congresses of the EAU and the AUA. These are big events with respect to release of the latest scientific trials, instructional courses, plenary sessions, and of course multiple ways to see and interact with advances in industry partners. But who orchestrates these massive events occurring over multiple days? Of course it requires a full team of expert staff members, and in both groups, they employ an outstanding Urologist to a multi-year contract to serve as secretary and be a principle organizer of the annual meeting. We asked each secretary general to share their perspectives with 5 questions.

Gopal Badlani–Secretary to the AUA 2011-2015. The New Orleans AUA will be Prof. Badlani’s last as AUA and will certainly be an exciting meeting and fitting celebration to an excellent term of service and creative updates to the annual meeting.

1) What excites you about your meeting format and location?

PAA: Stockholm of course is a major draw, but we don’t know if it will be Spring or Winter at the time. Forty percent of our draw is from beyond Europe—Latin America, China, and India. We know that Stockholm is an exotic city worth the trip, but hopefully they find the meeting and the quality of education worth the trip. Stockholm is recognized as one of the best venues, and our office staff knows venues across Europe. The problem here is that the Swedish economy is booming and its one of the most expensive cities in the world. We were able to downsize the hotel prices, but its very expensive. In addition, Pharma support for attendees has dropped from 80% to 60%. The weather has been rather decent.

GB: We changed our format this year to incorporate Friday as the first official day of the AUA Annual Meeting, showcasing a full day of research programs and a highly successful Crossfires: Controversies in Urology program. It certainly generated “buzz” and continued discussions surrounding such controversies throughout the meeting.

2) What about high impact studies being presented?

PAA: One coming up is the PREVAIL study with Enzalutamide “Pre-chemo”. We also have our own Swedish national cancer registry and there are some data coming out favoring early treatment of prostate cancer. This is one of the oldest in the world. Peter Wiklund will present this. Another that will be updated Tuesday is the European randomized screening trial. The principal investigator after Fritz Schroeder is Jonas Hugosson from Gothenberg. He got permission from Lancet to update the Swedish arm of that trial. You will find differences between centers and there will be an update with longer follow-up.

GB: Our plenary sessions highlighted late-breaking news, new AUA clinical guidelines and the latest advances in urologic medicine. It was in this forum, we heard from Dr. Anthony Fauci on ending the HIV/AIDS pandemic and its lifecycle from scientific advances to public health implementation.

It was also where attendees heard from Dr. Ajay Nangia about the adverse effects of common medications on male fertility to outstanding sessions on benign disease, the challenges in managing spinal cord injury patients with neurogenic bladder as well as mesh use for urinary incontinence (Drs. Flynn and Rovner).

Our International Prostate Forum more than tripled anticipated attendance. Dr. Andrew Schally, a recipient of the Nobel Prize in Medicine, as well as a number of experts from around the world, provided global perspectives on prostate cancer.

Eight debates on today’s hottest topics in urology were showcased through our standing-room only Crossfire-Controversies in Urology event. Our Town Hall transported attendees into the future of simulated surgical training and imaging. This session included presentations from experts and pioneers in 3D and molecular imaging as well as surgical simulation.

3) What are key metrics of the meeting?

PAA: We have 120 countries represented. Registration is about 700 off from Milan last year, but are pleased overall given the expense noted, and sponsorship from Pharma continues to decrease.

GB: Our meeting continues to attract over 15,000 attendees from over 120 countries. More than 2,200 abstracts were presented and more than 2,500 speakers.

4) What are key trends important to Urologists attending your meeting? Why do they attend?

PAA: There is a need for meetings like this for people to meet and to start up multi-institutional trials, even trans-Atlantic. We hope to facilitate translational research. For example, we facilitated the first ever World Chinese meeting—Taiwan, Hong Kong, and Mainland—all together, and very difficult to organize from a political viewpoint. We were very pleased with this and left politics aside.

GB: There are a number of major concerns affecting American urologists, including issues affecting fair and appropriate payment (e.g., the sustainable growth rate, or SGR, the formula which is used to set Medicare payments for U.S. physicians), certain provisions under the Affordable Care Act (such as the 90-day grace period for recipients of advanced payments in the large group health insurance market places) and the impact that unfunded mandates such as prior authorizations, required accreditations, etc., have on our practices. All of these issues are compounded by the fact that our U.S. physician workforce is shrinking and, unless significant steps are taken to fundamentally reform graduate medical education, the country will have an insufficient supply of physicians to adequately meet patients’ needs in a timely manner. This shortage is of specific note to urology, since we have the second-oldest surgical subspecialty workforce, and limits on funding for urology residency programs make it extremely difficult to get more medical students into urology residencies.

5) What are your impressions of the venue and city?

PAA: Honestly I was not involved in that decision-making. We have 70 people working full time in our office in Holland. We had our own congress consultants working, looking at new venues. We have mainly concentrated our annual congress to limited venues—Madrid, Barcelona, Paris, Vienna, Milan, London in the future, and in Germany Munich and Berlin. Scandinavia so far its only been Stockholm as we can take care of 15,000 people here and we have a good congress venue. In the future it will be Copenhagen as they have a new congress venue that is closer to Europe. So we are going to rotate between these venues. We have not been able to find a venue in Eastern Europe that accommodates that many people.

GB: We enjoyed being in sunny, warm Orlando in May. Orlando has a good mix of hotels to offer to our attendees – from an impressive full service Ritz Carlton to a few lower cost options such as the Days Inn and Marriott Courtyard. Overall, I think the Orlando Convention Center worked well for us. Looking forward, the excitement is in the air surrounding next year’s location, New Orleans May 15-20, 2015. Program planning begins this summer!

So there you have it. While most of us run around these meetings trying to figure out which session suits our interest, or where we have to moderate/speak next, the secretaries have a very different perspective. They worry about meeting formats, costs, weather, who will show up, what will they think. I was also impressed that while most of us tend to network on the fly by just walking around the venue and bumping into colleagues, the secretaries have very tight schedules run by their staff. I appreciate the time both gave to us. Note that the answers may flow differently as Per-Anders did a sit down interview with an iPhone recorder running, while Gopal gave me typed answers after the meeting.

Thank you to both secretaries on strong annual congresses.

John W. Davis, MD, FACS
Associate Editor, BJUI

AUA 2014 – Monday, Tuesday, Wednesday: “The Tweeter’s Congress”

May 22, 2014/2 Comments/by Khurshid Ghani

Thanks to @rmehrazin and @uroncdoc for a great summary of the first three days of #AUA14. This year’s meeting has been a phenomenal success, especially with regards to Twitter use during the Congress and the dissemination of content surrounding the meeting. You know how it goes – ‘sorry I can’t catch your session because I have to be somewhere else’. Well not anymore. Keep the #AUA14 search feed on your Twitter app, and the stream of information on posters/podiums or plenary was tremendous! One could be at multiple sessions at the same time. Indeed, Twitter use compared to last year’s meeting has increased by over 100%. Just as Tony Blair coined the term ‘the people’s Princess’ for Princess Diana – I am calling #AUA14 ‘the Tweeter’s congress’. In honour of that, I have created ‘Twitter-grams’ around themes. As the conference has too much to cover, I will concentrate on the big plenary sessions.

Twitter-gram 2: PCNL

Further plenary included the EAU lecture by Mr Marcus Drake on the management of LUTS. He announced the protocol of a European RCT enrolling 800 patients assessing invasive urodynamics versus noninvasive tests in men undergoing surgery for bladder outlet obstruction. This was followed by Dr Quentin Clemens, from @umichurology and Chair of the multidisciplinary approach to the study of chronic pelvic pain (MAPP) network. The objectives of this impressive multi-institutional study are to address underlying disease pathophysiology and natural history utilizing patient cohorts, biospecimens and animal models, as well as provide new information to inform patient management and future clinical trial design. More details can be found here.

The plenary then wrapped up with a discussion of the new AUA guidelines from Dr Morey on urotrauma and Dr Pearle on medical management of stone disease. Both can be viewed here:

Urotrauma
Medical management of kidney stones

Some important points from the urotrauma guidelines:

Imaging is necessary – immediate and delayed
Indications for renal trauma imaging include gross hematuria, microscopic hematuria and systolic blood pressure <90, or mechanism of injury suggest high index of suspicion.
Stable patients be managed non-invasively
For renal injuries Grade 4 or greater – follow-up imaging is advised
For ureteral trauma, immediate repair is indicated if complete injury and recognized in the operating room
In unstable patients, ureteral trauma can be managed with temporary urinary drainage
In presence of gross hematuria and pelvic fracture – patient must have cystography

Some important points from the medical management guidelines:

Thiazides are indicated in patients with recurrent calcium stones and hypercalciuria
Potassium-citrate therapy should be offered to patients with hypocitraturia and recurrent calcium stones
In patients with recurrent calcium stones and absence of metabolic abnormalities, both thiazides and potassium citrate should be offered
Allopurinol should be prescribed to patients with recurrent calcium stones elevated urinary uric acid and normal urinary calcium. It should not routinely be prescribed as first line therapy for patients with uric acid stones
In terms of follow-up, a 24 hour urine collection should be performed within 6 months of initiating treatment and at least annually thereafter

Monday – Townhall session

The ‘townhall’ session this year contained urology and non-urology experts who were questioned by the audience via text messages (but not Twitter! @AmerUrological). This session was moderated by Dr Inderbir Gill, and included experts from Hollywood on 3D imaging, a neuroscientist, molecular imaging scientists and surgical simulation pioneers. The session began with a talk on tissue level imaging in 3D, followed by Dr Tewari (@nycrobotics) introducing us to his research on visualizing nerves during robot-assisted radical prostatectomy. Dr Narula, Editor of the Journal of Cardiovascular Imaging, then gave a fascinating talk on “Who gets the Heart Attack? Imaging from Bench to Bedside and from Mummies to Population”. At the end of his talk, I had a strong urge to get my cholesterol checked as well as demand a CT angiogram. The simulation debate was entitled – “The giants of the past don’t need no stinkin’ simulators” – and was between Dr Carl Olsson (Against simulation) and Dr Robert Sweet (For). Dr Olsson was the man with all the right jokes, while Dr Sweet’s slides malfunctioned; although it was clear to the audience that in this era of reduced hours training, simulated surgical training is becoming the norm. Finally, only at the AUA meeting can you get the team behind 3D rendering for Hollywood provide an insight into the methodology of rendering. We all put on 3D glasses and watched a short clip of the film “Need for speed” in glorious 3D.

Tuesday – plenary

The morning began with a panel discussion between some very well known urologists on robotic vs. open robotic cystectomy. First on, Dr Hautmann argued against robotic cystectomy: “Optimal function was more important than the length of the incision or time to flatus”. He also argued there was a selection bias in robotic series, with healthier patients tending to be selected for robotic surgery. He closed by quoting Einstein: “make things as simple as possible but not simpler than that”.

Next was Dr Pruthi, an expert on robotic cystectomy. He felt the benefit of a robotic intracorporeal diversion was fewer GI complications, readmissions, and the potential to reduce ureteral stricture because of less ureteral mobilization with the robotic approach. While the ileal conduit robotically was simple and straightforward, he admitted he was unsure of robotic neobladders as this was more complex. The session closed with a frank statement by Dr Jay Smith, “It is unlikely any substantial difference in outcome will emerge between robotic vs open cystectomy”. However, he felt robotics was here to stay, as it was doubtful if the next generation of urologists would have the skills to obtain high-level open cystectomy results.

The plenary then resumed with the theme on PSA testing, and started with a panel discussion on tests to distinguish aggressive from non-aggressive prostate cancer before biopsy. Dr John Wei (@jtwei88) from @umichurology, spoke about the Michigan Prostate Score (MiPS) – a composite score consisting of three tests: PSA, urine T2:ERG gene fusion, and urine PCA3 level. Later on, to a jam jam-packed hall, Dr Penson (@urogeek), from Vanderbilt, delivered a state-of-the-art lecture on PSA testing guidelines. This excellent talk generated lots of Twitter traffic, which is illustrated in the Twitter-gram.

Wednesday – take home messages and wrap-up

The final day was not as busy as the other days as most delegates and all exhibitors had left. I too had to get back to work, but I was still able to catch up with #AUA14 via the twittersphere (thanks @chrisfilson). The best of the tweets from this last day are depicted in the final twitter-gram. I also recommend @cbayneMD for his top 5 conference highlights.

[caption id=”attachment_15430″ align=”alignnone” width=”1024′ label=’ Twitter-gram 4: final day

Overall, #AUA14 has been a fantastic conference, where records were set for Twitter participation and engagement in a urological meeting. I am still recovering!

Khurshid Ghani
University of Michigan, Ann Arbor, USA
@peepeeDoctor

Social media traffic broke all records at #AUA14 with over 1100 participants sending over 10,000 tweets and making almost 14 million digital impressions.

AUA 2014 – Friday, Saturday, Sunday: Orlando, FL

May 19, 2014/by Reza Mehrazin - Jeff Tomaszewski

As my flight descends into the home of Walt Disney and make believe in sunny Borelando, I can’t help wonder how #AUA14 will compare to the outstanding #EAU14 meeting held just one month ago. A great meeting requires equal parts place and content, and although Stockholm is without peer, there must be a reason Orlando is the third most visited city in the U.S., right? The solution to that mystery is for another day; ask elsewhere, as I have no idea. Review of the agenda on the #AUA14 app gives hope for this meeting. There is more quality scientific content than one can possibly absorb, and highlights include the new “Crossfire” program to address controversies in urology, the John K. Lattimer Lecture by Dr. Anthony Fauci (director of the National Institute of Allergy and Infectious Diseases), the Town Hall on imaging, simulation and animation (with speakers from Hollywood who make make-believe a reality and a living), #SUO14, and the release of three new AUA Guidelines on urotrauma, medical management of stones, and cryptorchidism.

Friday afternoon kicked off with the new “Crossfire” section featuring debates on a number of heated urology controversies. Debate topics included the use of synthetic slings for stress urinary incontinence (SUI), the role of urologists in administration of therapy for advanced and metastatic prostate cancer, and the probably overly discussed topic of open versus robotic surgery (for both partial nephrectomy and radical prostatectomy). In favor of synthetic mid-urethral slings for SUI, Drs. Kennelly and Rovner presented a wealth of data showing the efficacy of slings in both the short and long term. Drs. O’Connell and Blaivas countered that the pubovaginal fascial sling provides a safer alternative, with less potentially significant complications that far outweigh the benefits of having the operation.

Drs. Nelson and Lepor then argued in favor of open prostatectomy, which drew some colorful tweets:

Drs. Tewari and Menon presented compelling arguments for robotic prostatectomy, and while it is hard to declare a winner, the majority of urologists in the U.S. perform robotic assisted prostatectomy; the panelists stressed that outcomes depend more upon the surgeon than the technique, and people should perform whichever approach they are most comfortable with.

The robotic versus open debate then shifted to kidney surgery, with distinguished faculty Drs. Gill and Uzzo debating “minimally invasive partial nephrectomy is the new gold standard for renal cancer”, while Drs. Blute and Libertino argued in favor of open surgery. Although both sides had thought provoking arguments, presented data were all limited by their retrospective designs, institutional experience, or lack of validation. In my opinion, even with high volume surgeons, most patients with highly complex tumors or a renal mass in a solitary kidney undergo open surgery, which implies selection bias that limits the generalizability of robotic or laparoscopic partial nephrectomy. As contemporary experience with robotic surgery grows, we can anticipate that more complex lesions will be approached via MIS techniques in the future. We always love to throw in “randomized clinical trials are needed”… although I do think that IDEALLY prospective evidence would be great, however a clinical trial comparing MIS partial Nx to open techniques will be fraught with accrual challenges and are most likely not expected in the near future. Until more definitive prospective evidence is available, decisions regarding the optimal surgical approach for the renal mass should be determined by individual patient and surgeon preference, experience and comfort level.

Following the debate, Dr. Todd Morgan nicely summarized audience sentiment:

Dr. Declan Murphy provided perhaps the best sage advice regarding robotic versus open surgery:

Social Media continues to grow in urology, and Friday evening concluded with a wonderful party hosted by the AUA (@Americanurol) for the “UroTwitterati”. There was a great turnout, and #SoMe heavy hitters: @daviesbj, @declangmurphy, @dr_coop, @qdtrinh, @TheUrologist, @LoebStacy, and @Tdave attended along with “wannabe” youngsters (your current bloggers, @UROncDoc and @RMehrazin). The beauty of #SoMe is that it even allows members to participate in the meeting from home, including @uretericbud and @dytcmd. Urologists should sign up for a Twitter account and join. It is very engaging and addictive!

The jam-packed schedule continued on Saturday morning with the annual residents forum, during which the resident teaching award was awarded to Dr. Robert Uzzo from Fox Chase Cancer Center.

A variety of sections and societies also held meetings on Saturday. At the Association of American-Iranian Urologists, panelists Drs. Ghavamian and Samadi discussed the role of focal therapy in prostate cancer.

The remainder of Saturday was largely filled by the Society for Basic Urological Research and Society for Urological Oncology annual meetings. One highlight of the #SUO meeting was Dr. McDermott’s presentation on anti-PD-1 agents in kidney cancer. In a phase 1 RCT, Nivolumab (anti PD-L1 agent) showed efficacy for patients with metastatic RCC (n=34). There was a 29% objective response rate with a median progression-free survival time of 7.3 months. The drug was well tolerated with minimal severe adverse events, and remarkably, treatment free survival was achieved in a few patients. Immunotherapy represents an exciting and novel way target kidney cancer, and may well help usher in the era of personalized targeted therapy.

On Sunday, multiple poster and podium sessions were occurring simultaneously, which makes it hard to attend and see everything. The discussion on Twitter via #AUA14 made it possible to capture highlights from simultaneous sessions. During the Plenary session on Sunday, Dr. Fauci, Director of the National Institute of Health, Allergy and Infectious Disease Division, gave the annual Lattimer lecture. AIDS is an important topic for urologists because several aspects of the disease are specific to urology. “For example, the role of STD’s in increasing the transmissibility as well as the vulnerability of getting infected with HIV, the potential role of HPV vaccine in preventing HIV infection, and the importance of urologist issues associated with the drugs HIV patients are taking, including stones, renal insufficiency, voiding dysfunction, and erectile dysfunction,” remarked Dr. Fauci.

John P. Mulhall, Director of Male Sexual Health and Reproductive Medicine at Memorial Sloan Kettering Cancer Center, delivered the plenary state of the art lecture on radiation induced erectile dysfunction. It is an important topic, because “there are an increasing number of urologists who have hired a radiation oncologist or have a stake in an IMRT unit or do brachytherapy in their practices”, remarked Dr. Mulhall. “The pathophysiology of ED after pelvic radiation is very similar to that after radical prostatectomy based on three factors: nerve injury, arterial injury, and smooth muscle injury”.

The new AUA clinical guideline for cryptorchidism was also presented at the plenary session on Sunday. The highlights of the guideline:

Orhiopexy is the gold standard treatment for cryptorchidism in 2014
Initial radiographic studies are not necessary for the child with cryptorchidism
Surgery should be performed from 6 to 18 months after birth
Hormonal therapy should not be used as primary therapy to attempt to reposition the testis in the scrotum

Your bloggers,

Reza Mehrazin, M.D. and Jeffrey J. Tomaszewski, M.D.
Fox Chase Cancer Center, Philadephia, PA
Twitter @rmehrazin and @UROncDoc

Reaching a consensus…robotic radical cystectomy

May 9, 2014/4 Comments/by Declan Murphy

What is your impression of a “consensus statement”? We have these periodically in urology and they do tend to get widely read. One wonders, how difficult could it be for a bunch of urologists to reach a consensus on something?? Especially if, at the end of the day, we are all agreeing to cut something out?! It’s not like radiation or doing nothing are on the cards for this particular topic! How difficult could it be?

Well, let me give you a peak into the workings of the robotic-assisted radical cystectomy (RARC) Consensus Conference which took place at the City of Hope Hospital in California last weekend, the findings to be known as “The Pasadena Consensus Statement on RARC”. This two-day conference took place in the beautiful foothills of the San Gabriel Mountains in Southern California, and was hosted by Dr. Tim Wilson, Chief of Urology at City of Hope. The event was co-ordinated by the eminent New England Research Institute, led by Dr. Ray Rosen, and funded by a generous philanthropist affiliated with the hospital. The format of the meeting was familiar, as there has already been a Pasadena Consensus Statement on robotic-assisted radical prostatectomy, which was published in European Urology in 2012 along with four systematic reviews, all of which have been highly-cited. The conference invited a group of leaders in radical cystectomy, open as well as robotic, to participate and the resulting faculty features some highly-published figures in muscle-invasive bladder cancer, including some of the pioneers of RARC. These include:

Tim Wilson, City of Hope, California
Bernie Bochner, Memorial Sloan-Kettering, New York
Peter Wiklund, Karolinska, Sweden
Khurshid Guru, Roswell Park, New York
Eila Skinner, Stanford University, California
Joan Palou, Fundacio-Puigvert, Barcelona
Jim Catto, Editor-in-Chief, European Urology, Sheffield
Giacomo Novara, Padua, Italy
Bertrand Yuh, City of Hope, California
Declan Murphy, Peter MacCallum Cancer Centre, Melbourne
Magnus Annerstedt, Stockholm, Sweden
Arnulf Stenzl, Tuebingen, Germany
Kevin Chan, City of Hope, California
Jim Peabody, Vattikuti Urology Institute, Detroit

Photo courtesy of Dr Jim Catto.

The goal was to review the current evidence for RARC (by way of systematic reviews and other detailed review), and to agree a “Best Practices” white paper. We had been split into working groups and had submitted slides overviewing our topics ahead of time. The two-day schedule then allowed presentation of these slides with (very) detailed critique and discussion. Systematic review maestro Giacomo Novara had worked with Bertrand Yuh to complete the systematic reviews prior to the conference and findings from these also informed much discussion. Bernie Bochner (the most knowledgeable person I have ever met on the topic of muscle-invasive bladder cancer!), kindly agreed to present the findings from the MSKCC randomised controlled trial which are key data in this area. This paper is about to be submitted so the Pasadena group will be able to include these findings in the final papers.

So was it a cosy chat in the Californian sunshine with much nodding of heads on key topics? Well, occasionally! The group were very sociable with very lively interaction, but there was certainly robust discussion on certain topics. Some of these leaked out on Twitter as one might expect with a few prominent uro-twitterati in the room (@jimcatto, @giacomonovara, @declangmurphy, @joanfundi, @AStenzl, @jamesopeabody), and with a lively response from social media enthusiasts from around the world getting involved in the #RARC conversation (@dytcmd, @@uretericbud, @daviesbj, @dmsomford, @matthayn, @kahmed198, @uroegg, @UROncdoc, @urogill, @urorao, @nickbrookMD, @joshmeeks, @wandering_gu, @urologymatch, @urology_verona, @chrisfilson, @mattbultitude, @clebacle, @chapinMD, @ggandaglia, @urogeek, and more) – every corner of the globe involved!

At certain times, the weight of data for open radical cystectomy was difficult to counter, and led to lively discussion between Bernie and Khurshid. For confidentiality reasons, we can’t reveal key findings until the final papers have been written and published, but Twitter does allow a sneak peak:

A general lament was the lack of high-quality data overall, as tweeted in this quote from Arnulf Stenzl:

However, some of the big publications from the pioneering centres, especially the data from the International Robotic Cystectomy Consortium (IRCC), and the RCT from Memorial have given us plenty to consider.

Having been involved in another large consensus statement recently (The Melbourne Consensus Statement on the Early Detection of Prostate Cancer), I can tell you that these statements feature very robust discussion before consensus is reached, and occasionally consensus is not reached leading to topics being omitted. The chosen faculty for such statements are highly-knowledgeable leaders in the field, but often have views which are highly discordant. The Chair has a great challenge to moderate so that the final statements are agreeable to all, and I am sure that the Pasadena Statement on RARC will prove of great interest to all working in this field.

[The Pasadena Consensus Statement Best Practices white paper will be published in European Urology in coming months, along with two systematic reviews and a Surgery in Motion technique paper]

Declan Murphy is a urologist at Peter MacCallum Cancer Centre in Melbourne, Australia, and Associate Editor at BJUI. Twitter @declangmurphy

Disclosure – Declan Murphy received support to cover travel and accommodation costs through the New England Research Institute. No industry support was received by any participants in this conference.

EAU14 – Planning and executing a meeting session: perspective of the chairs

April 28, 2014/by John Davis

An interview with Prof. Noel Clarke on the EORTC-GU session

For an academic and/or key opinion leader in urology, the opportunity to plan and execute a meeting session is a tremendous honor, but one that comes with numerous challenges. The trivial but not-so trivial aspects involve the logistics: who will attend, who will speak, what do I do if a speaker cancels, what if the speakers do not stick to time, etc. Of course the easiest way to begin is to chair a session comprised of abstracts on a particular theme. This requires mainly the effort of preparing good questions for discussion and how to keep speakers on time (should we be nice?). The next level up is to plan a session with a broader theme that requires inviting specific speakers, framing debates, and then orchestrating it all into very usable take home messages for the audience. These are tremendous opportunities to come up with a vision for our field to consider.

At the EAU 2014, Prof Noel Clarke (GB) from our consulting editorial board was charged to organize the EORTC-GUCG session along with his co-chair Cora Sternberg (IT). I had a few questions for Prof Clarke, but really ended up just handing him my iPhone with the voice memo running and asking him how he went about planning the session:

“What we were trying to do was give a broad-based and sufficiently detailed overview of where we are in relation to different cancers and understanding of different cancer processes. And we tried to do that with specific reference to areas that have been strong in the EORTC-GU group in the past, particularly linking some of the trials that we’ve done with some of the basic science that is currently ongoing. And trying to project that forward as to how we might design future trials. And the emphasis really is on participation of clinicians with scientists and with data centers to try to overcome some of the problems associated with the prosecution of trials in the modern era. Hence our final talk with was Bertrand Tombal’s talk which is really how we would envisage planning and structuring trials as we go forward because it is certainly very different now than it was in the ‘70s when the EORTC was able to do really large scale trials, following on the ‘80s and 90’s to 2000’s [British pronunciation: “naughties”] where increasingly international trial groups, academic groups, found it difficult to get around the problems of finance, beaurocracy, new agents, interactions with Pharma, and so on. So that really was the essence of how we planned our session.”

Wow – what a gem. Didn’t really need a 2^nd question.

Figure 1: SPECTApros trial design

Prof. George Thalmann spoke on BCG therapy – an area in need of more standardized protocols and biomarkers for sensitivity/resistance. Ultimately we need successful treatment of CIS and prevention of NMIBC recurrence and progression. The first step towards success is with a high quality TUR that provides correct staging and therapy. On this note, he cited an EORTC study (Brausi et al. Eur Urol 2002) that showed 7.4-45.8% recurrence rates after TUR and adjuvant chemo when taken for first follow-up cysto. Next, the focus is on ideal BCG therapy in terms of timing, schedules and which strain of BCG. He cited RCT’s planed by SWOG and SAKK/EORTC looking at intradermal BCG 3 weeks before intravesical therapy to improve pre-existing immunity. Not all BCG strains perform equally, and there may need to be a prospective comparison. See Figure 2.

Figure 3: Prof. Necchi’s summary slide on the challenges of translational trials

Finally, Prof. Bertrand Tombal, Brussels (BE) presented “Next generation trials for urologists and uro-oncologists, where are we headed?” The introductory observation was that we are increasing the gap between what we know through evidence versus what we do in practice – including both things we do without quality evidence and things we do contrary to quality evidence. Specifically, less than 4% of articles in surgical journals are randomized trials, and most of those are evaluating medical therapies rather than surgery itself. Yet research is increasingly complex with regulatory demands, dependence on pharma, and related strategies to focus on large indications. The key recommendations were to raise important questions when it comes to benefit for patients, assess affordability, and bring trials to the patient rather than the other way around. The SPECTApros design was highlighted again with reference to its integration of nomograms predicting a specific outcome, imaging, and biomarker identification/validation.

So that’s the snapshot of the modern EORTC and I look forward to following the progression of these novel trial designs and strategies.

John W. Davis, MD FACS
Houston, TX, USA
Associate Editor, BJU International

The 2nd BJUI Social Media Awards – April 2014

April 22, 2014/1 Comment/by Declan Murphy

Following the inaugural BJUI Social Media Awards presented at the 2013 AUA Annual Meeting in San Diego, this year’s awards moved across the Atlantic to the EAU Annual Congress in Stockholm. Both of these conferences play host to intense social media activity and it is fitting that the BJUI Social Media Awards gets to acknowledge the Uro-Twitterati on both continents! Individuals and organisations were recognised across 16 categories including the top gong, The BJUI Social Media Award 2014, awarded to an individual or organization who has made an outstanding contribution to social media in urology in the preceding year. The 2013 Award was won by the all-conquering Urology Match portal which continues to innovate in social and digital media. There had been much anticipation and speculation ahead of time about who would win the top and bottom gongs, and whether or not the King of Twitter, Ben Davies @daviesbj, would be acknowledged

In keeping with the informality of the 2013 BJUI Social Media Awards (held in an Irish Bar in San Diego), this year’s ceremony was held in the Acoustic Bar of the Scandic Grand Central in beautiful Stockholm. Fifty of the World’s leading social media enthusiasts in urology gathered to meet up in person and to see who would be recognised. Yours truly once again played the role of MC wearing my hat of BJUI Social Media Editor, ably assisted by Matt Bultitude, BJUI Website Associate Editor, and Editor-in-Chief Prokar Dasgupta.

The full list of awardees, along with some examples of “best practice” in the urology social media-sphere can be found on this Prezi (https://prezi.com/iukizmhni9_w/bjui-social-media-awards-2014/). The winners are also listed here:

Most Read Blog@BJUI – The Melbourne Consensus Statement – accepted by Matt Cooperberg on behalf of the authors
Most Commented Blog@BJUI – Dr Rajiv Singal, Toronto, Canada
Best Blog Comment – Dr John Davis, Houston, USA
Best BJUI Tube Video – Blue Light cystoscopy RCT – accepted by Shamim Khan on behalf of colleagues at Guy’s Hospital
Best Urology Conference for Social Media – EAU Annual Congress, Stockholm 2014
Best Social Media Campaign – Stacy Loeb, for her birthday party campaign
“Did You Really Tweet That” Award – Ben Davies, Pittsburgh, USA
Best Urology App – jointly awarded to BJUI (Matt Bultitude) and European Urology (Cathy Pierce) for new iPad apps
Innovation Award 2014 – @UroQuiz – Nathan Lawrentschuk, Melbourne, Australia (accepted by Paul Anderson)
#UroJC Award – Vincent Misral, Paris, France
Best Selfie – Mike Leveridge, Toronto, Canada
Best Urology Facebook Site – American Urological Association (accepted by Matt Cooperberg)
Best Urology Journal for Social Media – European Urology (Jim Catto)
Best Urology Organisation – Urological Society of Australia & New Zealand (David Winkle)
The BJUI Social Media Award 2014 – Stacy Loeb, New York, USA

BJUI Editor Prokar Dasgupta presenting awards to Jim Catto, Matt Cooperberg and Stacy Loeb

Many of the Award winners were present to collect their awards themselves, including the omnipresent Stacy Loeb who was awarded our top gong to huge applause.

A special thanks to our outstanding BJUI team at BJUI in London, Scott Millar and Helena Kasprowicz, who manage our social media and website activity and who were present on the night.

For more pictures from the evening, please visit BJUI Associate Editor John Davis’ Flickr https://www.flickr.com/photos/jdhdavis/sets/72157643916525665/ page.

Declan Murphy is Associate Editor for Social Media at BJUI. He is a urologist in Melbourne, Australia

Follow Declan on Twitter @declangmurphy and BJUI @BJUIjournal

EAU14 – ESOU citations

April 14, 2014/2 Comments/by John Davis

Have You Read This?…A bibliography of cited papers on prostate cancer at the Joint Meeting of The European Section of Oncological Surgery (ESOU) and EORTC—Genito-Urinary Cancer Group.

At the BJUI, as with any journal, the published articles are peer reviewed and editorial board reviewed. The process starts with a triage editor who screens for basic methodology, importance of the topic, and potential for citation factor impact. The top 50% are sent for full peerreview, which includes 3 reviewers (ad hoc or from the board). Full review is organized by an associated editor who assigns (and then begs) the 3 reviewers to complete their task, and then makes a final recommendation to the editor in chief. I could go on about this interesting process, but the point is that a published paper is often really just the opinion of 4-5 experts in the field, including the editor. Once published, however, papers are then kept alive by repeated citation and meeting discussions, or disappear intoPubMed and forgotten. Future papers that cite a previously published paper will help the impact factor of that journal. But what about congress events and their cited works? At the EAU 2014, as with any congress, key opinion leaders are asked to give talks, make arguments, and prove their points. They may do so with personal experiences, videosor modern abstract quotes, but often they cite recent peer review publications. At the joint session meeting of the ESOU and EORTC-GUCG, I noted the following cited publications from the prostate cancer talks. How many have you read so far?

On the topic of circulating tumor cells (CTCs) in prostate cancer, Professor S. Osanto of Leiden (NL) cited (partial citations):

1. Hanahan D et al. The hallmarks of cancer. Cell 2000

2. Klein CA. Cancer. The metastasis cascade. Science 2008.

3. Gerlinger M et al. Intratumor heterogeneity and branched evolution revealed by multiregionsequencing. NEJM 2012

4. Allard WJ et al. Tumor cells circulate in the peripheral blood of all major carcinomas but not in healthy subjects or patients with nonmalignant diseases. ClinCancer Research 2004

5. de Bono JS et al. Circulating tumor cells predict survival benefit from treatment in metastatic castration-resistant prostate cancer. Clin Cancer Research 2008

6. Attard G et al. Characterization of ERG, AR, and PTEN gene status in circulating tumor cells from patients with castration-resistant prostate cancer. Cancer Res 2009.

7. Cristofanilli M. Circulating tumor cells, disease progression, and survival in metastatic breast cancer. NEJM 2004.

8. Goldkorn A et al. Circulating tumor cell counts are prognostic of overall survival in Southwest Oncology Group trial S0421: A phase III trial of docetaxel with or without atrasentan for metastatic castration-resistantprostate cancer. J Clin Oncol 2014.

From these papers, the conclusions were many and included: 1) CTS can detect early relapse, genomic signatures, target identification, and treatment decisions, 2) surrogate marker for response, and 3) emergence of resistance.

Next, the focus shifted to the popular technical points and outcomes of open versus minimally invasive radical prostatectomy. Bernardo Rocco (IT) cited the following papers in support of robot-assisted radical prostatectomy for high risk PCa

9. Yuh et al. The role of robot-assisted radical prostatectomy and pelvic lymph node dissection in themanagement of high-risk prostate cancer: A systematic Review. Eur Urol 2014

10. Montorsi et al. Best practices in robot-assisted radical prostatectomy: recommendations of the Pasadena Consensus Panel. Eur Urol 2012.

11. Silberstein JL et al. A case-mix adjusted comparison of early oncological o utcomes of open and robotic prostatectomy performed by experienced high volume surgeons. BJU Int 2013.

12. Hu JC. Comparative effectiveness of robot-assisted versus open radical prostate cancer control. Eur Urol2014

13. Ploussard G et al. Pelvic lymph node dissection during robot-assisted radical prostatectomy efficacy, limitations, and complications—a systematic review of the literature. Eur Urol 2013.

14. Prasad SM et al. Variations in surgeon volume and use of pelvic lymph node dissection with open and minimally invasive radical prostatectomy. Urology 2008

15. Cooperberg MR et al. Adequacy of lymphadenectomy among men undergoing robot-assisted laparoscopic radical prostatectomy. BJU Int 2010

16. Feifer AH et al. Temporal trends and predictors of pelvic lymph node dissection in open or minimally invasive radical prostatectomy. Cancer 2011

17. Ficarra et al. The European Association of Urology Robotic Urology Section (ERUS) survey of robot-assisted radical prostatectomy (RARP). BJU Int 2013.

18. Gandaglia G et al. Is robot-assisted radical prostatectomy safe in men with high-risk prostate cancer? Assessment of perioperative outcomes, positive surgical margins, and use of additional cancer treatments. J Endourol 2014.

19. Ou Y.C. et al. The trifecta outcome in 300 consecutive cases of robotic-assisted laparoscopic radical prostatectomy according to D’Amico risk criteria. EJSO 2013.

20. Lavery HJ et al. Nerve-sparing robotic prostatectomy in preoperatively high-risk patients is safe and efficacious. Urol Oncol 2012.

21. Montorsi F. Robotic prostatectomy for high-risk prostate cancer: translating the evidence into lessons for clinical practice. Eur Urol 2014

From these citations, the conclusions were that: 1) RP is an adequate treatment for high risk prostate cancer, 2) robotic approach is not inferior to open as far as oncological outcome, 3) lymph node template and yield are adequate in experienced hands in RARP setting, 4) functional outcome after RARP in high risk is preserved, nerve sparing is feasible in selected patients, and 5) Costs of RARP are related to surgical volume and experience. So there you see a typical meeting presentation—13 papers in 15 minutes plus additional commentary and abstract data.

Next, Prof. Declan Murphy presented the Australian experience with robot-assisted RP for cT3a prostate cancer. With overlapping topics, it was no surprised some papers were recited from above including #9, #12,He cited:

22. Evans et al. Patterns of care for men diagnosed with prostate cancer in Victoria from 2008-2011. Med JAust 2013

23. Wilt T et al. Radical prostatectomy versus observation for localized prostate cancer. NEJM 2012

24. Connoly SS et al. Radical prostatectomy as the initial step in multimodal therapy for men with high-risk localized prostate cancer: initial experience of 160 men. BJU Int 2012.

From these citations, Prof. Murphy concluded that: 1) radical prostatectomy has minimal benefit for low risk men, especially older, 2) The biggest benefit is in high risk disease, 3) active surveillance is being embraced in Australia, 4) RARP is safe and effective with similar outcomes to ORP, 5) RARP has less positive margins and less additional therapy compared to ORP 6) extended PLND not limited by robotic approach.

Prof. Axel Heidenreich then took the opposite point of view in support of open radical prostatectomy. Despite the references above, he pointed out that there is still no long-term data for robotic prostatectomy, although not proving that with pathologic staging we would expect anything different. Cost of course can be quite better for open. He also cited for papers showing positive margins of < 12% in pT3 disease, compared to many other open and minimally invasive series where it is usually 25% and higher. Repeat citations: #9. He also cited:

25. Robertson C et al. Relative effectiveness of robot-assisted and standard laparoscopic prostatectomy as alternatives to open radical prostatectomy for treatment of localized prostate cancer: a systematic review and mixed treatment comparison meta-analysis. BJUI 2013.

26. Vora AA et al. Robot-assisted prostatectomy and open radical retropubic prostatectomy for locally-advanced prostate cancer: multi-institution comparison of oncologic outcomes. Prostate Int 2013

27. Punnen S et al. How does robot-assisted radical prostatectomy (RARP) compare with open surgery in men with high-risk prostate cancer? BJU Int 2013

28. Sooriakumaran P et al. A multinational, multi-institutional study comparing positive surgical margin rates among 22393 open, laparoscopic, and robot-assiste radical prostatectomy patients. Eur Urol2014

29. Alemozzafar M et al. Benchmarks for operative outcomes of robotic and open radical prostatectomy: results from the health professionals follow-up study.Eur Urol 2014

30. Davison BJ et al Prospective comparison of the impact of robotic-assisted laparoscopic radical prostatectomy versus open radical prostatectomy on health-related quality of life and decision regret. Can J Urol 2014

31. Bolenz C et al. Costs of radical prostatectomy for prostate cancer: a systematic review. Eur Urol 2014

From these citations, he concluded that 1) open radical prostatectomy is still viable, 2) not needed for low risk, 3) lack of long-term data for RARP, 4) no inferiority in terms of functional and oncological outcome, or quality of life, 5) better cost effectiveness, especially with median case load of < 300 RP’s per year.

I hope you find this reading list useful. Could you transfer such a bibliography to an effective review article? Probably not, and we can ask associate editor Quoc Trinh to comment or write a separate blog on the emerging field of systematic reviews, such as the multiple cited reference 9 by Yuh et al. A systematic review needs to conform to standards such as the PRISMA guidelines—see www.prisma-statement.org –which is “an evidence-based minimum set of items for reporting in systematic reviews and meta-analyses. Therefore we have an interesting difference in standards between a meeting presentation and a formal peer-reviewed systematic review—the former can hand-pick articles to make a point, while the latter must be thorough, transparent, and reproducible.

John W. Davis, MD FACS

Houston, Texas (USA)

Associate Editor, BJUI