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 #ROC: http://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 |