Monthly Archives: January 2013

Transcript of January 2013 #urojc

The paper discussed for the January 2013 International Urology Journal Club on Twitter discussion was on the subject of the prostate health index.  http://www.ncbi.nlm.nih.gov/pubmed/23206426

We were very fortunate to have Dr Stacy Loeb, the principle author of this paper available for the discussion. I am sure that all of you will agree that she has made a wonderful contribution and it has indeed been a privilege to have such expertise on board.

iurojc
Best Tweet prize for January has been donated by @USANZUrology who are of course the organizers of @urologymeeting – all are welcome #urojc

StorkBrian
#urojc @iurojc How about a shout out for our sponsor?

iurojc
Some useful background information behind the components of phi #urojc http://t.co/q1CqnS1A

iurojc
To provide some context, who amongst you have access to phi testing? – or not sure? Don’t be shy. #urojc

iurojc
January Best Tweet prize donated by @USANZUrology RT “@StorkBrian#urojc @iurojc How about a shout out for our sponsor?”

matthayn
No phi up in Maine #urojc #moremoosethanpeople

StorkBrian
#urojc Will freely admit no experience with Phi Unless of course you mean Phi Beta Kappa 🙂

DrRKSingaltegh
@iurojc #urojc Not us here in Cda.

DrRKSingaltegh
Looking fwd to discn to decide how hard 2push”@iurojc: To provide some context,who amongst you have access2phi testing? or not sure? #urojc

StorkBrian
#urojc Curious the costs associated with this type of testing as opposed to those associated with a standard total PSA

DrHWoo
I’ve seen local promotional material indicating phi available in Australia. Had a few patients ask. #urojc

DrHWoo
RT @BJUIjournal: Joining January’s #urojc discussion? Read @DrHWoo‘s blog on how it got started http://t.co/kOhKGyDl

iurojc
#urojc phi has FDA and EU and TGA (Aust) approval – this of course does not endorse phi.

DrRKSingaltegh
@LoebStacy In US what is relative cost of pro PSA to current free spa and PSA ratio? #urojc #costconsciouscanadian #prostatecancer

iurojc
#urojc Reminder that phi calculated as (p2PSA/fPSA) x (square root of PSA)

LoebStacy
@iurojc That’s correct- #phi approved in Europe, Australia and USA. However, doesn’t yet have CPT code in USA #urojc

iurojc
WHO standard for PSA calib commonly used outside USA. Study aimed to evaluate phi cutoffs using WHO rather than Hybritech. #urojc

iurojc
@LoebStacy Does FDA approval cover Canada? #urojc

iurojc
@LoebStacy What’s a CPT code for the non-US urologists? #urojc

_TheUrologist_
@iurojc No – Health Canada has jurisdiction up here (usually a bit delayed but similar to FDA, except for $ome things like Provenge) #urojc

daviesbj
@_TheUrologist_ @iurojc we let you make independent decisions in Canada? #urojc

_TheUrologist_
.@iurojc I assume that p2PSA can be measured from the same blood vial as PSA? #urojc

LoebStacy
@iurojc CPT=Current Procedural Terminology code for billing medical services. Until CPT code issued, insurance won’t reimburse #urojc

_TheUrologist_
@daviesbj @iurojc indeed – that’s why there are only 16 robots up here! #urojc

daviesbj
@_TheUrologist_ @iurojc #urojc I get it. You make independent poor decisions

DrHWoo
@_TheUrologist_ My understanding is yes but your lab either has to have the Beckman Coulter machine to measure p2PSA or refer it on #urojc

DrHWoo
Just confirmed phi avail thru the largest lab in NSW- out of pocket cost A$95(~US$100). #urojc

DrHWoo
Also confirmed that PCA3 testing available in Australia – cost $495 plus well massaged prostate & urologist’s fatigued index finger #urojc

DrRKSingaltegh
Independent deliberation RT @daviesbj@_TheUrologist_ @iurojc #urojc I get it. You make independent poor decisions

DrRKSingaltegh
Forgot to add #urojc RT @DrRKSingaltegh@DrHWoo About the same in Canada

DrRKSingaltegh
RT @DrRKSingaltegh: Part of the reason why PCA3 too cumbersome for me in daily clinical setting @_TheUrologist_ @iurojc @DrHWoo #urojc

DrRKSingaltegh
just to mix up #urojc NHL hockey lockout over. Video by Ophtho classmate of mine #thisisCanada #talentedmdocs #backtoJC http://t.co/7sZr46Tl

prokarurol
RT @BJUIjournal: Joining January’s #urojc discussion? Read @DrHWoo‘s blog on how it got started http://t.co/kOhKGyDl

IsaacThangasamy
RT @iurojc#urojc Reminder that phi calculated as (p2PSA/fPSA) x (square root of PSA)

cooperberg_ucsf
Hey, shouldn’t we be more academic about #urojc? Before covering logistics & intl $/€ coverage, what do y’all think of the paper? @iurojc

cooperberg_ucsf
Personally I’ve always been a bit skeptical about #phi per se (as opposed to -2proPSA on its own or as a %). #urojc

cooperberg_ucsf
Studies like this will tend to make PSA itself look worse than it is since this is a pre-tested urology pop (mean PSA 5 in both grps) #urojc

IsaacThangasamy
RT @cooperberg_ucsf: Hey, shouldn’t we be more academic about #urojc? Before covering logistics & intl $/€ coverage, what do y’all think of the paper? @iurojc

IsaacThangasamy
@cooperberg_ucsf Can you please say why? Interesting to hear different views from AUS urologists too. #urojc

cooperberg_ucsf
Also would be curious to know thoughts re: phi etc. compared to HK panel Lilja/Vickers at mskcc are working on. http://t.co/oQzEIoUp #urojc

daviesbj
#urojc also. Do we need to find more prostate cancer? And if we do shouldn’t it be higher grade dz #deepdaviesthoughts

dytcmd
@daviesbj I agree. The phi still finds more Gleason <7 cancer at all ranges. This is still more overdiagnosis, min better than tPSA #urojc

USANZUrology
RT @BJUIjournal: Joining January’s #urojc discussion? Read @DrHWoo‘s blog on how it got started http://t.co/kOhKGyDl

daviesbj
@dytcmd #urojc that was not in the Urology Times cliff note version of this paper! Dang. #deepdaviesthoughts #besttweetofday

mescaleen
What is it exactly RT @DrHWoo: I’ve seen local promotional material indicating phi available in Australia. Had a few patients ask. #urojc

Tdave
You GU Onc tweeps are too complicated! #StonesAreEasy #idostones #urojc

Tdave
That said, whatever we can do to help diagnosis. Just make it easy to do for us slower folk #urojc

DrRKSingaltegh
Stones far easier!Traditional #endourology still the best RT @Tdave: You GU Onc tweeps are too complicated! #StonesAreEasy #idostones #urojc

LoebStacy
@DrHWoo @iurojc This is important point- #PCA3 more $, needs physician visit for DRE; whereas #phi is blood test can do at lab #urojc

DrRKSingaltegh
Agreed.just needs to be much better 2 overcome existing test. @LoebStacy @DrHWoo @iurojc #urojc

LoebStacy
@cooperberg_ucsf @iurojc #PSA, free PSA and proPSA all validated markers- seems efficient to test performance in combined measure #urojc

DrRKSingaltegh
@LoebStacy @DrHWoo #urojc Clearly we need to do better but good clinical judgement still is paramount. Don’t sure PHI is an aha moment

LoebStacy
@daviesbj @iurojc agree that holy grail is to selectively find clinically significant #prostate cancer. #Phi is associated w grade #urojc

StorkBrian
#urojc I’m concerned more testing options will only further muddy the waters of understanding for patients, media, and referring physicians

LoebStacy
@DrRKSingaltegh @drhwoo @iurojc Agree that better markers still needed, physician judgement is key, multivariable approach critical #urojc

StorkBrian
@DrHWoo #urojc Curious under what circumstances and/or how often anyone/everyone is using PCA3

DrRunz_Urology
@StorkBrian @DrHWoo Using PCA3 on all Pts with rising PSA with – Bx; active surveillance Pts at time of Dx and q1-2 years + ? #urojc

StorkBrian
@DrRunz_Urology Do you routinely biopsy your active surveillance patients after 1 year or just check PCA3 if PSA and DRE stable? #urojc

JamesDuthie1
#urojc Klotz says no one ever died from CaP smaller than 1cm in diameter, so if not visible on MRI probly not significant. Angry responses?

iurojc
@cooperberg_ucsf Definitely agree that we need to get to the paper. Still worthwhile knowing who has it. Besides we got 48 hours. 😎 #urojc

DrRunz_Urology
PCA3 is actually a biomarker. But since it is made by HGPIN, it is not a pure one. #urojc

StorkBrian
@DrRunz_Urology #urojc I think that’s a very interesting approach. Anyone else using PCA3 as part of their active surveillance protocol?

DrSWeinstein
Paper seems to be a triumph for statistical method over the value for imdivid pt Will still biopsy PSA 10 even if PHI low #urojc

DrHWoo
Columns are benign, cancer and total respectively – comments? #urojc http://t.co/Kheb0rri

DrSWeinstein
?PHI is an oxymoron, tells about disease in prostate not health,?confusing for pts #urojc

DrSWeinstein
PHI ? adds another costly layer to already difficult area ? could be useful in lower PSA levels 2-4 any studies in this area#urojc

JamesDuthie1
#urojc @DrHWoo perennial problem of selection bias with new diagnostic tool. This is not a screening population, PSA has already contributed

UroOncMD
#urojc @iurojc phi is an improvement. @LoebStacy ROC is shifted favourably, but what is the extent to which it reclassifies subjects?

dytcmd
@DrHWoo @iurojc I see this the problem; overlap of means/SD –add more than tPSA and clin judgement? Does knowing phi avoid bx? no #urojc

dytcmd
@StorkBrian @drrunz_urology @iurojc what’s the data supporting serial PCA3 w/surveillance? #urojc

LoebStacy
@UroOncMD @iurojc Great comment! Net reclassification analysis not done in this, but is more informative than ROC- good future idea #urojc

_TheUrologist_
@StorkBrian @DrHWoo very rarely. Discussion usually “test to hope for a # that says no Bx, or just repeat Bx if PSA/ DRE change” #urojc

_TheUrologist_
@StorkBrian @DrRunz_Urology no, but good Q to answer, and some #urojc players have large AS cohorts under study…

DrRKSingaltegh
@UroOncMD @iurojc @LoebStacy Also how much different is the curve from PCA3? #urojc

DrRKSingaltegh
@_TheUrologist_ @StorkBrian @DrHWoo Agree. I think what Mike says represents current #prostatecancer #biopsy approach in Cda #urojc

LoebStacy
@UroOncMD @iurojc For #urojc, here’s reference on net #reclassification analysis to evaluate new markers beyond #ROChttp://t.co/CE2sH3FF

DrRKSingaltegh
@LoebStacy @UroOncMD @iurojc Stacy,forgive the lack of academic chops from me. Did you look at #phi in a tighter PSA range (1.5-3)? #urojc

UroOncMD
@LoebStacy perhaps beyond #urojc. Biomarker era has spawned methodological research in incremental value when added to models, ROC etc

LoebStacy
@UroOncMD #urojc Agree-stats are also evolving, and we must delve deeper into whether new #markers actually improve clinical #decisionmaking

_TheUrologist_
@DrHWoo 2pPSA numbers are tight. Wondering if biological variability of isoform is small enough to keep useful http://t.co/O8parGjS #urojc

_TheUrologist_
@DrHWoo not reassured as well by 16% mean fPSA in cancer patients. Dogma says worry at <10% #urojc

LoebStacy
@DrRKSingaltegh @UroOncMD @iurojc #urojc This study is PSA 2-10. Prior #p2PSA study with more on PSA 2-4 specifically: http://t.co/8cZhRuNE

LoebStacy
@_TheUrologist_ @DrHWoo #urojc #NCCN says #fPSA >25% no bx, <=10% bx, 10-25% indeterminate consider bx- need better risk stratification

DrRKSingaltegh
@LoebStacy @UroOncMD @iurojc Thank you.Looks about the same at 2-4.That range is where the daily diagnostic dilemma lies for us all #urojc

LoebStacy
@dytcmd @StorkBrian @DrRunz_Urology @iurojc #urojc We looked at #PCA3 in Johns Hopkins #AS– didn’t predict progression. http://t.co/cgcViz9T

_TheUrologist_
@LoebStacy @DrRKSingaltegh @UroOncMD @iurojc so here we are 9 years later…#wheresthebeef #urojc

LoebStacy
@dytcmd @StorkBrian @DrRunz_Urology @iurojc #urojc Recently we found that phi is assoc with progression on surveillance http://t.co/AsIoBatq

DrRKSingaltegh
@LoebStacy @dytcmd @StorkBrian @DrRunz_Urology @iurojc Not surprising. AS may be better served by understanding where MRI fits in. #urojc

LoebStacy
@StorkBrian @DrHWoo #urojc #PCA3 FDA approved to aid in decision for #repeat bx after neg initial bx, so that’s when I use it.

LoebStacy
@DrRKSingaltegh @dytcmd @StorkBrian @DrRunz_Urology @iurojc #urojc Agree about great value of MRI for AS- likely much better than markers

DrRKSingaltegh
Gotta operate in am.Shutting down now @iurojc Thks @LoebStacy 4 outstanding effort. Great to see a global perspective. When does #urojc end?

_TheUrologist_
@DrRKSingaltegh @iurojc runs 48h, and agree: @LoebStacy is REGULATING #urojc – great resource and input for us plebs!

cooperberg_ucsf
@StorkBrian @DrRunz_Urology We are looking at PCA3 (among other markers) in a serious way in AS through @CanaryFound PASS #urojc #staytuned

cooperberg_ucsf
RT @daviesbj#urojc also. Do we need to find more prostate cancer? And if we do shouldn’t it be higher grade dz #deepdaviesthoughts

LoebStacy
@_TheUrologist_ @DrRKSingaltegh @iurojc #urojc Enjoying the discussion, thanks for participating! Congrats @DrHWoo on this great initiative

DrRKSingaltegh
@_TheUrologist_ @iurojc @LoebStacy Will check in again tomorrow! #urojc. Should REGULATING get its own hashtag?

LoebStacy
RT @_TheUrologist_@DrRKSingaltegh @iurojc runs 48h, and agree: @LoebStacy is REGULATING #urojc – great resource and input for us plebs!

cooperberg_ucsf
.@LoebStacy @iurojc #urojc Right, but how well vetted is the specific formula? In 2ndary screen setting, maybe just check -2proPSA? #cheaper

DrHWoo
@cooperberg_ucsf @LoebStacy @iurojc I must admit that I have always been curious as to how the formula came about. #urojc

iurojc
#urojc is in full swing with 12/48 hrs done. Welc to our European/UK urologists waking up to join disc. @EricTopol @JimCatto @prokarurol

iurojc
Looking forward to the thoughts of our European colleagues to the excellent discussion on #urojc so far @Joddens @dirkjmkdr @giacomonovara

iurojc
Look forward to ANZ input into current #urojc disc now that surgery is done. @declangmurphy @DrDanielMoon @SpernatUrology @DrDavidMalouf

iurojc
@prokarurol @erictopol @jimcatto Hope to have your opinion on #urojc discussion so far. @MattBultitude @benchallacombe @Ben_L_Jackson

JimCatto
@iurojc #urojc phi/PCA3 not made impact in UK. I hate to admit it but @daviesbj nailed it! Do we need tests that find more low risk CaP?

fgomsan
#urojc PCA3 popular in Spain for pts with – biopsy and suspicion of PCa, 2pPSA and PHI not widely used, 3 Tesla mp MRI gaining momentum

dmsomford
RT @iurojc: Looking forward to the thoughts of our European colleagues to the excellent discussion on #urojc so far @Joddens @dirkjmkdr …

daviesbj
RT @JimCatto@iurojc #urojc phi/PCA3 not made impact in UK. I hate to admit it but @daviesbj nailed it! Do we need tests that find more …

iurojc
#urojc MT“@benchallacombe@cooperberg_ucsf @loebstacy maths beyond me but looks as if someone juggled variables around & came up with it

iurojc
#urojc MT“@lawrentschuk: Congrat a step 4ward 4PCa but really need Y/N nt cont data-gr8 additn 4 nomograms. Gd 2c focus on GS 7+REAL disease

iurojc
Gr8 to see input from @benchallacombe @lawrentschuk of @BJUIjournal fame. Reminder for all to use the #urojc hashtag. Keep up the great disc

StorkBrian
#urojc @DrHWoo Note 2 self… It appears lots of markers in the global urology tool box w no clear consensus on how/when to use them

StorkBrian
@Berci This Month’s #urojc @iurojc is taking place right now. Discussion centered on Phi. http://t.co/eyPdC3Gh via @sharethis

iurojc
RT @StorkBrian@Berci This Month’s #urojc @iurojc is taking place right now. Discussion centered on Phi. http://t.co/eyPdC3Gh via @sharethis

iurojc
Trainees are encouraged to participate in #urojc . Please don’t make me have to create a Trainee Best Tweet Prize to hook you guys in!

iurojc
If you’re watching this excellent #urojc discussion on the side lines, do send a tweet to check in & to let us know you’re watching/enjoying

matthayn
What about #phi in men with prior negative biopsy? #urojc

uretericbud
RT @JimCatto@iurojc #urojc phi/PCA3 not made impact in UK. I hate to admit it but @daviesbj nailed it! Do we need tests that find more …

UrologyMatch
RT @fgomsan#urojc PCA3 popular in Spain for pts with – biopsy and suspicion of PCa, 2pPSA and PHI not widely used, 3 Tesla mp MRI gain …

Ben_L_Jackson
@iurojc #urojc enjoying the chat. Not sure phi is enough of a step-change to break through in cost-conscious UK #NHS

UrologyMatch
@_TheUrologist_@DrRKSingaltegh @iurojc runs 48h, and agree: @LoebStacy is REGULATING #urojc – great resource and input for us plebs!”

UrologyMatch
RT @cooperberg_ucsf: .@LoebStacy @iurojc #urojc Right, but how well vetted is the specific formula? In 2ndary screen setting, maybe just …

alexcsmall
Med student in NYC here! @iurojc RT “If you’re watching this excellent #urojc discussion on the side lines, do send a tweet”

Ben_L_Jackson
RT @iurojc: Trainees are encouraged to participate in #urojc . Please don’t make me have to create a Trainee Best Tweet Prize to hook you guys in!

DrRKSingaltegh
In Canada, be sure to follow #prostatecancer discussion as part of #urojc via @iurojc great 4 @ProstateCancerC @UofTFamilyMed & @CFMSFEMC

DrRKSingaltegh
RT @iurojc#urojc MT“@lawrentschuk: Congrat a step 4ward 4PCa but really need Y/N nt cont data-gr8 additn 4 nomograms. Gd 2c focus on G …

iurojc
#urojc MT“@DrRunz_Urology@LoebStacy It appears there was a trend towards higher PCA3 in pts with progression.Q is what’s the cutoff?”

iurojc
RT @alexcsmall: Med student in NYC here! @iurojc RT “If you’re watching this excellent #urojc discussion on the side lines, do send a tweet”

iurojc
RT @fgomsan#urojc PCA3 popular in Spain for pts with – biopsy and suspicion of PCa, 2pPSA and PHI not widely used, 3 Tesla mp MRI gain …

captfun99
RT @matthayn: No phi up in Maine #urojc #moremoosethanpeople

iurojc
RT @JimCatto@iurojc #urojc phi/PCA3 not made impact in UK. I hate to admit it but @daviesbj nailed it! Do we need tests that find more …

captfun99
#urojc enough lipstick on the PSA pig. Time for a new screening paradigm. No phi at BIDMC, though Marty Sanda is an author on the paper

IsaacThangasamy
Enjoying following discussion on Phi via #urojc thanks to @LoebStacy @iurojc and others. #PSAcomplexities

AndrewLenis
@alexcsmall @iurojc And from Cleveland! Obtaining twitter training wheels now, will participate next month following the match! #urojc

JimCatto
#urojc why find more low risk cap? @EUplatinum: It’s Time to Change the Treatment Paradigm for Prostate Cancer! http://t.co/Uw5pMPCf

LoebStacy
@iurojc @drrunz_urology PCA3>35 in 61% prog,48% w/o prog. PCA3>25 in 74% w/prog, 61% w/o prog.AUC 0.59. Couldn’t find reliable cutoff #urojc

LoebStacy
@jimcatto Jay Smith: “Can decide tx or nontx once CaP dx, but not dx in 1st place surely burns bridges” Screen –> AS if low risk! #urojc

AndrewLenis
@BC_Gill Think you’d enjoy this effort by @iurojc, follow #urojc for monthly journal club. See blog on @BJUIjournal for details. PHI this mo

LoebStacy
@fgomsan #urojc We are also using #mpMRI at #NYU for patients with negative prior prostate biopsy/elevated PSA, and those on AS.

LoebStacy
RT @IsaacThangasamy: Enjoying following discussion on Phi via #urojc thanks to @LoebStacy @iurojc and others. #PSAcomplexities

JimCatto
@LoebStacy #urojc agreed – but we are underusing AS

patthetech
RT @DrRKSingaltegh: In Canada, be sure to follow #prostatecancer discussion as part of #urojc via @iurojc great 4 @ProstateCancerC @Uof …

Joddens
Then, is phi usefull in following patients on AS as predicting tool for progression? #urojc

iurojc
RT @AndrewLenis@BC_Gill Think you’d enjoy this effort by @iurojc, follow #urojc for monthly journal club. See blog on @BJUIjournal for details. PHI this mo

iurojc
RT @JimCatto#urojc why find more low risk cap? @EUplatinum: It’s Time to Change the Treatment Paradigm for Prostate Cancer! http://t.co/Uw5pMPCf

DrRKSingaltegh
Happy to still only do the prostates. Laser still working just fine for the stones! #urojc @Tdave @_TheUrologist_ @beikoMD

DrDavidMalouf
RT @BJUIjournal: Joining January’s #urojc discussion? Read @DrHWoo‘s blog on how it got started http://t.co/kOhKGyDl

DrDavidMalouf
@LoebStacy Agree with Stacy. Can limit overDx but stuck with it for present. We can reduce over Rx using established protocols #urojc

DrDavidMalouf
Anti PSA lobby overstate psych harm from low risk CaP Dx. Low levels of emotional distress when Rx with AS on established protocols #urojc

soph_cash
@LoebStacy @jimcatto great debate. What about the psychological and social implications of a ca diagnosis in low risk group? #urojc

MattBultitude
#urojc CaP diag so complicated now. PSA; F:T; PCA3; Phi; MRI;pre-Bx MRI;3T MRI; histoscan;TP Biopsy; MRI fusion. No wonder pts get confused

iurojc
RT @MattBultitude#urojc CaP diag so complicated now. PSA; F:T; PCA3; Phi; MRI;pre-Bx MRI;3T MRI; histoscan;TP Biopsy; MRI fusion. No w …

StorkBrian
@MattBultitude #urojc Finding it all a bit confusing myself… To many choices Seemingly very little consensus

DrRKSingaltegh
Agreed.Most patients are sophisticated and most #prostatecancer Rx docs are good communicators (to wit this #urojc@DrDavidMalouf

DrRKSingaltegh
& in view of that & clearly with still so much to do still my own bias is to cast wide net &separate diagnosis from Rx @DrDavidMalouf #urojc

daviesbj
#urojc it’s not that confusing. Stick with PSA unless you have a (multiple?) neg bx with rising PSA – then consider pca3 and/or MRI. Phi??

StorkBrian
@daviesbj #urojc Agree, but you could also throw in a saturation bx or a template bx into the mix as well just to make it > complicated

daviesbj
@StorkBrian #urojc don’t confuse the Canadians

LoebStacy
@MattBultitude #urojc Definitely much to consider but w/o a single perfect marker, best is personalized #screening using multiple variables

LoebStacy
@DrRKSingaltegh @DrDavidMalouf #urojc W/o screening–> more mets–> limited choices. Screen intelligently–> tx high-risk/watch low-risk

BiotechStockRsr
RT @daviesbj#urojc it’s not that confusing. Stick with PSA unless you have a (multiple?) neg bx with rising PSA – then consider pca3…

DrDavidMalouf
RT @LoebStacy@DrRKSingaltegh @DrDavidMalouf #urojc W/o screening–> more mets–> limited choices. Screen intelligently–> tx …

UroOncMD
@LoebStacy @DrRKSingaltegh @DrDavidMalouf #urojc Just checked in. We’re straying from the paper and becoming philosophical @daviesbj

UroOncMD
Agree with @LoebStacy @DrRKSingaltegh @DrDavidMalouf #urojc

DrRKSingaltegh
The less we know the better philosophy looks! #urojc @UroOncMD @LoebStacy @DrDavidMalouf @daviesbj

_TheUrologist_
@UroOncMD @daviesbj if multiple neg Bx and high PCA3, still can’t call Ca, have to Bx again. MRI might provide a target/show ant mass #urojc

_TheUrologist_
@UroOncMD @daviesbj PCA3 = trying to avoid bx with low #; MRI = trying to find Bx target. How about re-Bx incl. TZ instead? #urojc

_TheUrologist_
@daviesbj @UroOncMD @StorkBrian Saturation Biopsy was the name of my punk band’s sophomore album in 1997 #urojc

_TheUrologist_
@daviesbj @UroOncMD agree 5ARI a good idea, esp if goal is to weed out the G6s. Just have to navigate discussion with a bit of care #urojc

DrDavidMalouf
@UroOncMD @daviesbj @_theurologist_ #urojc MRI to avoid Dx low risk CaP? Like the idea but need to see the data from more than a few centres

uretericbud
“Screen or not to screen” & “Treat or not to treat” debates pivot on accurate quantifications of risk http://t.co/t5qgDNRt #darkages #urojc

iurojc
@UroOncMD @loebstacy @drrksingaltegh @drdavidmalouf @daviesbj Correct. Paper was actually about calibration with WHO PSA standard #urojc

iurojc
@UroOncMD @loebstacy @drrksingaltegh @drdavidmalouf @daviesbj But getting philosophical is what tends to happen on Twitter #urojc

_TheUrologist_
@njtouma @UroOncMD @daviesbj true – dedicated GU radiologists rare and MR characteristics not perfectly elucidated #urojc

iurojc
RT @_TheUrologist_@daviesbj @UroOncMD @StorkBrian Saturation Biopsy was the name of my punk band’s sophomore album in 1997 #urojc

StorkBrian
@_TheUrologist_ @njtouma @urooncmd Lots of misconceptions about Canadian Health care system in US Prostate MRI an option in Canada? #urojc

StorkBrian
@_TheUrologist_ @njtouma @urooncmd If so, in community hospitals or just major academic centers? #urojc

UroOncMD
@StorkBrian @_TheUrologist_ @njtouma #urojc An option? A reality, but widespread access an issue. Maybe a good thing!

njtouma
@StorkBrian @urooncmd academic place with @_TheUrologist_ recently lost our radiologist w/ interest/fellowship in #prostate MRI #urojc

DrHWoo
@_TheUrologist_ @daviesbj @urooncmd @storkbrian What happened to SWA as per previous journal article disc? #urojc http://t.co/l5NmuQcY?

StorkBrian
@UroOncMD @_theurologist_ @njtouma Didn’t mean to imply you didn’t have MRI Only curious if it is difficult to get approval given $ #urojc

njtouma
@UroOncMD @_theurologist_ @daviesbj although imperfect, use the arbitrary 35. Feel a lot better the further away on either side #urojc

njtouma
@StorkBrian @urooncmd @_theurologist_ usually access not too bad although waits for #prostate Ca may be longer; 8 weeks #urojc

DrHWoo
@_TheUrologist_ @njtouma @urooncmd @daviesbj mpMRI Prostate has ⬆machine time➡ resource issues – lots of data👉reporting a pain. #urojc

_TheUrologist_
@DrHWoo @daviesbj @UroOncMD @StorkBrian do you have to abstain for 72h before a 2pPSA draw? 😉 #urojc

UrologyMatch
RT @DrHWoo@_TheUrologist_ @daviesbj @urooncmd @storkbrian What happened to SWA as per previous journal article disc? #urojc http://t …

_TheUrologist_
PSA – we defend it vehemently while yearning for its replacement (we’re right on both accounts) #urojc

StorkBrian
RT @_TheUrologist_: PSA – we defend it vehemently while yearning for its replacement (we’re right on both accounts) #urojc

_TheUrologist_
Cynic says: the end of PSA would be fatal to many high-profile and highly-mined databases. Replacement might meet ++resistance #urojc

njtouma
@_TheUrologist_ too much #prostatecancer infrastructure: Dx, risk stratification, Rx, Outcomes, and f-up built around #PSA #urojc

UroOncMD
@_TheUrologist_ maybe a small force. I’m in favour of improving PSA because of its widespread availability, funding, and low cost. #urojc

DrHWoo
#urojc ROC AUC improvement increment over cost/hassle ratio may not be all that bad -are we being too dismissive of role for phi? @LoebStacy

DrRKSingaltegh
We are blessed here in Toronto though. Have certainly used #MRI much more this year #urojc @UroOncMD @StorkBrian @_TheUrologist_ @njtouma

DrRKSingaltegh
Have local expertise. Still need to figure out resourcing for the longer term #urojc @UroOncMD @StorkBrian @_TheUrologist_ @njtouma

DrRKSingaltegh
Cdn Hcare is very good Resources force us to choose wisely #cdnpoli #urojc #onpoli #onhealth @StorkBrian @_TheUrologist_ @njtouma @urooncmd

DrRKSingaltegh
Fresh from @CMAJ_News today. Cdn thoughts on CaP screening. Speaks to my view in 2013 @iurojc #urojc #onhealth #onpoli http://t.co/DzVX95Dz

DrRKSingaltegh
I know we have gotten away from the article a bit but this global dialogue among colleagues on #prostatecancer is FANtastic! #urojc @iurojc

_TheUrologist_
Why PSA must stay MT @njtouma: too much #prostatecancer infrastructure: Dx, risk strat, Tx, Outcomes, and f-up built around #PSA #urojc

UrologyMatch
Urology “Education” at it’s best? #overmarketing #vegas #urojc http://t.co/M3WWxUiy

DrSWeinstein
Really enjoying the high level of discussion on this online”podium session”thanks to @DrHWoo and @LoebStacyThe best value CPD ever!#urojc

dytcmd
RT @_TheUrologist_: PSA – we defend it vehemently while yearning for its replacement (we’re right on both accounts) #urojc

IsaacThangasamy
@LoebStacy @drrksingaltegh @drdavidmalouf Intelligent screening + proper risk strat seem to be the most imp’t take home msg for jnrs #urojc

DrHWoo
@DrHWoo@UroOncMD @_theurologist_ Can argue that phi is part of making smarter use of PSA to help risk stratify who we biopsy. 1/2 #urojc

DrHWoo
@UroOncMD @_theurologist_ phi readily available with accept cost. Easy & time eff to perform. No sore bum/finger/claustrophobia 2/2 #urojc

fgomsan
#urojc And I would keep an eye on transperineal mpMRI & US transperineal fusion biopsies as the future gold standard when bp indicated

iurojc
Amazing participation in January #urojc so far- >35 participants responsible for >200 tweets & from all over world. Our biggest effort yet

jcfed6363
RT @LoebStacy@DrRKSingaltegh @DrDavidMalouf #urojc W/o screening–> more mets–> limited choices. Screen intelligently–> tx …

DrRKSingaltegh
Terrific way to phrase it. Agree completely! @LoebStacy @DrDavidMalouf #urojc #onhealth

DrRKSingaltegh
RT @iurojc: Amazing participation in January #urojc so far- >35 participants responsible for >200 tweets & from all over worl …

DrRKSingaltegh
Outstanding dialogue on #prostatecancer with global perspective #urojc #onhealth #onpoli @irojc

Ben_L_Jackson
RT @iurojc: Amazing participation in January #urojc so far- >35 participants responsible for >200 tweets & from all over worl …

WestCoastUrol
#urojc PHI – useful quantification of what #USANZ urologists tend to do anyway – intelligent interpretation of PSA individualized to the pt

DrDavidMalouf
RT @iurojc: Amazing participation in January #urojc so far- >35 participants responsible for >200 tweets & from all over worl …

DrHWoo
Any of the Sonic Healthcare labs in AU can organise phi testing. Cost is $95 and non rebatable. #urojc RT @WestCoastUrol which lab Henry?

StorkBrian
RT @iurojc: Amazing participation in January #urojc so far- >35 participants responsible for >200 tweets & from all over worl …

IsaacThangasamy
RT @iurojc: Amazing participation in January #urojc so far- >35 participants responsible for >200 tweets & from all over worl …

qdtrinh
Stories of 2012: “First #urojc was held in November and has been a global success.” http://t.co/MVWzG5FE @iurojc @DrHWoo @BJUIjournal

IsaacThangasamy
RT @qdtrinh: Stories of 2012: “First #urojc was held in November and has been a global success.” http://t.co/MVWzG5FE @iurojc @DrHWoo @B …

Tdave
RT @iurojc: Amazing participation in January #urojc so far- >35 participants responsible for >200 tweets & from all over worl …

NeomedicInt
A readjustable sling for the treatment of female incontinence http://t.co/T7l3JwSZ #Remeex #urojc

UrologyMatch
RT @qdtrinh: Stories of 2012: “First #urojc was held in November and has been a global success.” http://t.co/MVWzG5FE @iurojc @DrHWoo @B …

LoebStacy
@drhwoo @_theurologist_ @urooncmd #urojc Agree-good to be wary of the many new markers but #phi easy/cheap, worth considering for paradigm

LoebStacy
@soph_cash @jimcatto #urojc Great point- shared decision-making, good patient counseling are important to avoid unnecessary worry on AS

LoebStacy
@uretericbud #urojc Agree that better #prostate Ca risk stratification is key for all decisions. More data points –> more informed choices

LoebStacy
@isaacthangasamy #urojc Current paradigm not sustainable-need better risk strat for bx & AS/tx. Look more at #phi combined w other variables

MattBultitude
@LoebStacy-so norm DRE,abn PSA<10. Will phi prevent biopsies?Still 11.3% risk of ca if phi low (0-28.9) of which 21.6% are Gleason 7+ #urojc

DrDavidMalouf
RT @qdtrinh: Stories of 2012: “First #urojc was held in November and has been a global success.” http://t.co/MVWzG5FE @iurojc @DrHWoo @B …

IsaacThangasamy
@LoebStacy Thanks for a great discussion again. #urojc