Monthly Archives: February 2013

February #urojc analytics

Image

Note the first dip in tweets – this corresponded with the SuperBowl which probably affected North American participation for a several hours but they bounced back later.

Screen Shot 2013-02-06 at 9.42.15 PM

 

An excellent participation with quality tweeting.

Winner of the Best Tweet was Dr Rajiv Singaltegh

 

February 2013 #urojc Transcript

The paper discussed was the PCOS Study  published in the NEJM in January 2013.

http://www.ncbi.nlm.nih.gov/pubmed/23363497

N Engl J Med. 2013 Jan 31;368(5):436-45. doi: 10.1056/NEJMoa1209978.

Long-term functional outcomes after treatment for localized prostate cancer.

Source

Department of Urologic Surgery and the Center for Surgical Quality and Outcomes Research, Vanderbilt University, Nashville, TN 37203, USA.

Abstract

BACKGROUND:

The purpose of this analysis was to compare long-term urinary, bowel, and sexual function after radical prostatectomy or external-beam radiation therapy.

METHODS:

The Prostate Cancer Outcomes Study (PCOS) enrolled 3533 men in whom prostate cancer had been diagnosed in 1994 or 1995. The current cohort comprised 1655 men in whom localized prostate cancer had been diagnosed between the ages of 55 and 74 years and who had undergone either surgery (1164 men) or radiotherapy (491 men). Functional status was assessed at baseline and at 2, 5, and 15 years after diagnosis. We used multivariable propensity scoring to compare functional outcomes according to treatment.

RESULTS:

Patients undergoing prostatectomy were more likely to have urinary incontinence than were those undergoing radiotherapy at 2 years (odds ratio, 6.22; 95% confidence interval [CI], 1.92 to 20.29) and 5 years (odds ratio, 5.10; 95% CI, 2.29 to 11.36). However, no significant between-group difference in the odds of urinary incontinence was noted at 15 years. Similarly, although patients undergoing prostatectomy were more likely to have erectile dysfunction at 2 years (odds ratio, 3.46; 95% CI, 1.93 to 6.17) and 5 years (odds ratio, 1.96; 95% CI, 1.05 to 3.63), no significant between-group difference was noted at 15 years. Patients undergoing prostatectomy were less likely to have bowel urgency at 2 years (odds ratio, 0.39; 95% CI, 0.22 to 0.68) and 5 years (odds ratio, 0.47; 95% CI, 0.26 to 0.84), again with no significant between-group difference in the odds of bowel urgency at 15 years.

CONCLUSIONS:

At 15 years, no significant relative differences in disease-specific functional outcomes were observed among men undergoing prostatectomy or radiotherapy. Nonetheless, men treated for localized prostate cancer commonly had declines in all functional domains during 15 years of follow-up. (Funded by the National Cancer Institute.).

February 2012 #urojc transcript

Healthcare Social Media Transcript

From: Sun Feb 03 12:00:00 PST 2013
To: Tue Feb 05 12:00:00 PST 2013
 
iurojc
Let the February #urojc begin!

iurojc
We are fortunate to have primary & senior authors @ResnickMJ & @urogeek participating in Feb #urojchttp://t.co/YwneTNbz

iurojc
#urojc We now welcome any comments or questions you may have regarding the PCOS paper just published in@NEJM

StorkBrian
RT @iurojc: We are fortunate to have primary & senior authors @ResnickMJ & @urogeek participating in Feb#urojc http://t.co/Ywn …

Ben_L_Jackson
RT @iurojc: Let the February #urojc begin!

iurojc
Can data derived from men treated >15 yrs ago reasonably be used to counsel new diag men on their prospects for functional recovery #urojc

LoebStacy
@iurojc @NEJM #urojc Media interpret #prostate treatment universally CAUSE #erectiledysfunction, but 79-85% ED w/ age http://t.co/RhxzS85X

LoebStacy
@iurojc @NEJM #urojc Pop-based data: men >65 w/o #prostatecancer therapy: 15% mild, 27% mod, 42% complete ED on MMAS survey; 79% ED by IIEF

StorkBrian
RT @iurojc#urojc We now welcome any comments or questions you may have regarding the PCOS paper just published in @NEJM

DrHWoo
@LoebStacy Agree. A common problem where critics of prostate cancer treatment feed media with half stories to fuel their own agendas #urojc

DrRKSingaltegh
@iurojc don’t think so but it is good snapshot of what we did do. #urojc

DrRKSingaltegh
Therapies are better but outcomes probably incrementally better not magnitude. See robot #urojc

DrRKSingaltegh
The harrowing thing about these pts regardless of baseline popln QofL metrics is that they received Rx wout disease stratification #urojc

DrRKSingaltegh
@iurojc certainly younger men with meaningful disease relying on this QofL data to make decision in 2013 would concern me #urojc

DrRKSingaltegh
64% of men in surgery group had Gleason 2 to 4 disease. Doesn’t likely even exist in 2013 #urojc#activesurveillance

drjonrees
@DrRKSingaltegh @iurojc so where should they go for this info? #urojc

StorkBrian
@iurojc MT Agree! A common problem where critics of prostate cancer treatment feed media with 1/2 stories to fuel their own agendas #urojc

DrRKSingaltegh
@drjonrees As PCOS shows we have not done a good job.Need to use this data but understand in context of natural Hx of the disease #urojc

matt_coward
#urojc Too many changes in Tx since these men were tx’d 18 yrs ago for mostly gleason 2-4 ca. Interesting historical lesson though.

DrRKSingaltegh
@drjonrees My worry is for a man with GL 8+ disease who is 40 to not understand implications. Need to interpret all info with doc #urojc

DrRKSingaltegh
@LoebStacy @iurojc @NEJM Still looking for the fountain of youth after 500 years #whereisponcedeleon #urojc

StorkBrian
@DrRKSingaltegh Indeed, because of media, spend >>> amounts of time trying to explain to Pts even w high grade cancer why need TX #urojc

daviesbj
#urojc football!!!

alexcsmall
Any advice for young investigators? RT @cooperberg_ucsf “When #PCOS started @urogeek was a junior resident! #foresight #perseverance” #urojc

UroOncMD
@daviesbj #urojc sorry but I’m also at the superbowl jc

iurojc
@UroOncMD @daviesbj Yes, you has warned us but look forward to everybody coming on line afterwards #urojc

Williamson_SR
@DrRKSingaltegh: 64% had Gleason 2-4 #urojc” would be interesting to see modern grading- likely most would be GS6 or more today

DrRKSingaltegh
@Williamson_SR #urojc probably not. Many I suspect would be ASAP or not called cancers

DrHWoo
@resnickmj @urogeek – unimpressive functional results after surgery; any comments abt center expertise, technique modification since #urojc

Williamson_SR
@DrRKSingaltegh #urojc GS2 may be AAH, 3-5 is more variable, some could even be 7. Not too relevant to study though http://t.co/j8XfK6vn

DrHLN
Incontinence & ED are big ticket adverse outcomes of surgery. What of other late presenting radiation induced complications? #urojc

IsaacThangasamy
@LoebStacy @iurojc @nejm This data is a great counter for those unable to refrain from rubbishing PCa treatment! #urojc

IsaacThangasamy
RT @DrRKSingaltegh: 64% of men in surgery group had Gleason 2 to 4 disease. Doesn’t likely even exist in 2013#urojc #activesurveillance

uretericbud
@matt_coward “The only thing new in the world is the history you don’t know.” -Truman #urojc

UrologyMatch
RT @LoebStacy@iurojc @NEJM #urojc Pop-based data: men >65 w/o #prostatecancer therapy: 15% mild, 27% mod, 42% complete ED on MMAS s …

UrologyMatch
RT @Williamson_SR@DrRKSingaltegh #urojc GS2 may be AAH, 3-5 is more variable, some could even be 7. Not too relevant to study though …

DrRKSingaltegh
@uretericbud @matt_coward #urojc And those that don’t learn from history are doomed tp repeat it

DrHWoo
#urojc MT“@UroOncMD@ResnickMJ @urogeek Similar to Sanda et al. NEJM 2010. Generalizability paramount to CaP care given high incidence.”

UroOncMD
#urojc Why is it that the urologic community always criticizes longterm well designed studies with”The data are no longer applicable today?”

DrRKSingaltegh
@UroOncMD #urojc Data is very applicable. Study welldesigned. It’s just that overTx in many in this group makes side effects more appalling

UroOncMD
#urojc @ResnickMJ @urogeek To contextualize PCOS, prev. of complete ED tripled from 5 to 15% between ages 40 & 70 y.in Mass male aging study

DrRKSingaltegh
@DrHWoo @resnickmj @urogeek #urojc Agree very unimpressive. Likely all experienced. Patient-reported outcomes likely always more reflective

DrRKSingaltegh
@UroOncMD #urojc. Much needed. That would be the third arm in a modern PCOS don’t you think? I tell everyone to think of AS as therapy

iurojc
Awaiting input from our European colleagues on #urojc regarding PCOS @dirkjmkdr @Joddens @F_Montorsi@roboturoloog @thetaub @giacomonovara

iurojc
Looking forward to our UK colleagues joining in on the #urojc discussion @roboturologist @JimCatto @prokarurol@MattBultitude @urorao

DrRKSingaltegh
Great idea. “@UroOncMD@DrRKSingaltegh Absolutely. Will also add to the debate on risk of ED with multiple TRUS biopsy.” #urojc

iurojc
@prokarurol Happening now -discussing PCOS study just published in @nejm – use hashtag #urojc in all tweets- do search on # to see full disc

iurojc
Current #urojc discussion on PCOS published a few days ago. Right or wrong, this will be a reference paper on long term CaP Rx morbidity.

prokarurol
@iurojc #urojc surprised by the bowel urgency data although no difference at 15 years

prokarurol
@iurojc #urojc stats and more stats to deal with unequal groupings!

prokarurol
@iurojc #urojc are patients happier if they are clear of cancer @15 years or would they rather be potent?

prokarurol
@iurojc @nejm #urojc please consider a blog or comment for the BJUI on PCOS

_TheUrologist_
@DrRKSingaltegh @UroOncMD agree – this study is less about treatment choice and more about aging, anatomy and the biology of healing #urojc

_TheUrologist_
.@UroOncMD talking out of both sides of our mouths: “CaPr nat hx is 20 years” “these data do not reflect current tx, tech, etc”. #urojc

prokarurol
@BJUIjournal #urojc Henry Woo, CME Editor and friends discussing the PCOS functional outcome trial at the international JC. Await a blog!

_TheUrologist_
As rational CaPr treatment shifts toward higher risk (wide feilds, less nerve sparing), functional outcomes may actually get _worse_ #urojc

DrHWoo
@prokarurol @bjuijournal Will definitely write a blog piece for this one #urojc

uretericbud
@prokarurol @iurojc Yes, but stats not without major limitations: http://t.co/PCrG3zGP #unmeasuredconfounders#urojc

iurojc
Would be most interested to hear views of @SimonChapman6 @kennylinafp on PCOS. Pls use #urojc hashtag.http://t.co/bR3pk4ep

iurojc
Tip for newbies- on Twiiter, do search of #urojc – this is how you’ll find all tweets relating to discussion

iurojc
Another reminder to all – don’t forget to use #urojc in all tweets.

dytcmd
@DrRKSingaltegh @drhwoo @urogeek #urojc I disagree abt “all experienced”–its ave US results of 1994-5, not acad ctrs. But below expected.

ResnickMJ
@UroOncMD @urogeek #urojc

ResnickMJ
#urojc Most men today recieve Rx in the community, not captured in many single-inst or multi-center studies.

ResnickMJ
@uretericbud @prokarurol #urojc As we all know RP and EBRT groups are rarely “equal” and high-quality CER req. analytic measures to balance.

LoebStacy
@ResnickMJ @iurojc @NEJM #urojc A key strength of this study is showing that many short-term differences between RP & RT dissipate in time

LoebStacy
@DrRKSingaltegh @UroOncMD #urojc UK ProtecT trial of RP vs. RT vs. AS should provide 3-way oncologic and functional comparisons in 2015

Tdave
So, basically, at 15yrs, it doesn’t matter what we do? #Akward #urojc

DrRKSingaltegh
Now that is well worth waiting for! @LoebStacy @UroOncMD #urojc

DrRKSingaltegh
@ResnickMJ @LoebStacy @UroOncMD UR right but they do rely on what we tell them. Need 2 manage stress/anxiety with good communication #urojc

DrRKSingaltegh
Always matters. Happiest patient is one at peace with choice made RT @Tdave: So, basically, at 15yrs, it doesn’t matter what we do? #urojc

dytcmd
@ResnickMJ @uretericbud @prokarurol #urojc Any thoughts on why RP patients developed similar bowel urgency at 15 yrs? Aging?

daviesbj
#urojc I promise I will never operate on a Gleason score 2 – 4 #deepdaviesthoughts

daviesbj
Can you say prunes (sorry dried plums) usage rate #urojc Any thoughts on why RP patients developed similar bowel urgency at 15 yrs? Aging?

urorao
@daviesbj #urojc Has anyone re-looked at these slides to see whether they were indeed cancers or not?!#unnecessarytreatment

uretericbud
RT @LoebStacy@DrRKSingaltegh @UroOncMD #urojc UK ProtecT trial of RP vs. RT vs. AS should provide 3-way oncologic and functional compa …

IsaacThangasamy
RT @UroOncMD#urojc Why is it that the urologic community always criticizes longterm well designed studies with”The data are no longer …

DrHWoo
@dytcmd @drrksingaltegh @urogeek With so many urologists doing handful cases/annum, poor overall functional outcomes may still apply? #urojc

DrHWoo
@dytcmd @drrksingaltegh @urogeek Further support for regionalization of cancer care? #urojc @maxinesun@qdtrinh @jdsammon

JacobsAlanna
@AllanAllanjc #urojc GS2 may be AAH, 3-5 is more variable, some could even be 7. Not too relevant to study though …

dytcmd
@ResnickMJ @loebstacy @drrksingaltegh @urooncmd don’t forget the bias of uros–we are paid to rx/operate, $ incentive is not for AS #urojc

dytcmd
@DrHWoo @drrksingaltegh @urogeek @maxinesun @qdtrinh @jdsammon it’s already 2 to robot, referrals/market forces to robospecialists. #urojc

UrologyMatch
RT @DrHWoo@dytcmd @drrksingaltegh @urogeek Further support for regionalization of cancer care? #urojc@maxinesun @qdtrinh @jdsammon

UrologyMatch
RT @daviesbj: Can you say prunes (sorry dried plums) usage rate #urojc Any thoughts on why RP patients developed similar bowel urgency a …

UrologyMatch
RT @LoebStacy@ResnickMJ @iurojc @NEJM #urojc A key strength of this study is showing that many short-term differences between RP & …

uretericbud
@LoebStacy @resnickmj @iurojc @urogeek Arguably ability to comprehend surveys dissipates with time #urojc#dementia

oussama_elhage
@ResnickMJ @iurojc Would be interesting to know the percentage of recurrence and hormone tx in each arm. major impact on sexual fx. #urojc

iurojc
@ResnickMJ Hi Matt- appreciate your great contribution – If you include the hashtag #urojc in all tweets, everybody will see your comments 😷

iurojc
#urojc MT @ResnickMJ@uretericbud I Would be interested in association of cognition & response to instrument as well @LoebStacy @urogeek

iurojc
#urojc RT“@ResnickMJ: Certainly limitations given tech. advancements, but functional deficits likely far more common than we like to admit!

urorao
#urojc At 15 yrs, 322 patients (27.7%) in the RP group had died, as had 247 men (50.3%) who underwent DXT. Wud this skew results at 15 yrs?

iurojc
#urojc RT“@ResnickMJ@iurojc Unfortunately, absent high-quality modeling techniques, long-term data requires long-term f/u.”

iurojc
#urojc MT“@ResnickMJ@LoebStacy Followed matched controls to 5y. 15 f/u would allow for meaningful est of risk w Rx superimposed on aging.”

iurojc
#urojc MT“@ResnickMJ@LoebStacy Unfortunately, PCOS doesn’t permit estimate of incremental risk of ED w Rx. See Cancer, 101(9), 2011–2019.

iurojc
#urojc RT“@urogeek@ResnickMJ @uretericbud @LoebStacy @iurojc in theory patients who had dementia/incompetent likely dropped out”

DrHWoo
#urojc MT“@urogeek@dytcmd @DrRKSingaltegh @maxinesun @qdtrinh @jdsammon study is pop-based so includes ALL. results not diff than PROST-QA

UroOncMD
@ResnickMJ @urogeek #urojc couldn’t agree more

DrHWoo
#urojc MT“@urogeek@dytcmd @DrRKSingaltegh @maxinesun @qdtrinh @jdsammon suspt tht even with referrals, PROs not nearly good as we promise”

iurojc
@urogeek Thanks for great input so far. Don’t forget to use the hashtag #urojc on all of the tweets – otherwise followers may miss

DrHWoo
Attn all. Friendly remember to use the hashtag #urojc to avoid followers missing discussion. cc @UroOncMD@urogeek @resnickMJ #urojc

DrHWoo
#urojc RT“@maxinesun@urogeek @dytcmd @drrksingaltegh @qdtrinh @jdsammon selective avoidance prob more pertinent & feas in this context.

DrHWoo
#urojc RT“@urogeek@UroOncMD @dytcmd @DrHWoo @DrRKSingaltegh @maxinesun @qdtrinh @jdsammonref is Anderson et al JU 2012”

DrHWoo
#urojc MT“@urogeek@UroOncMD @dytcmd @DrRKSingaltegh @maxinesun @qdtrinh @jdsammon 2008-80% perf in hosp in highest quartile vol, 65%-2000

DrHWoo
#urojc MT“@dytcmd@urogeek @DrRKSingaltegh @maxinesun @qdtrinh @jdsammon without a doubt. we think we are better at this than we are.”

DrRKSingaltegh
@DrHWoo @dytcmd @urogeek Certainly volume is better but make no mistake the functional results still poor#urojc

DrRKSingaltegh
@DrHWoo @dytcmd @urogeek @maxinesun @qdtrinh @jdsammon Hard 2 completely regionalize disease that is so common.Maybe for robot though #urojc

DrRKSingaltegh
@dytcmd @ResnickMJ @loebstacy @urooncmd I have always said if we treat AS as therapy and compensate accordingly this point is moot #urojc

DrRKSingaltegh
@dytcmd @ResnickMJ @loebstacy @urooncmd Nevertheless good clinical decisions always reward in the long run #urojc

DrRKSingaltegh
@urogeek @DrHWoo @dytcmd @maxinesun @qdtrinh @jdsammon And therefore very reflective of reality out there at least in 1995 in #urojc

DrRKSingaltegh
@dytcmd @urogeek @DrHWoo @maxinesun @qdtrinh @jdsammon Patients do want to please the clinician when asked. PRO is more accurate #urojc

DrRKSingaltegh
@urogeek @UroOncMD @dytcmd @DrHWoo @maxinesun @qdtrinh @jdsammon That’s better than I thought#urojc

qdtrinh
@DrRKSingaltegh @DrHWoo @dytcmd @urogeek @maxinesun @jdsammon things might change with more AS in low-risk, less screening by PCP, … #urojc

DrRKSingaltegh
@qdtrinh @DrHWoo @urogeek @UroOncMD @dytcmd @maxinesun @jdsammon Stay away! you are on vacation #urojc

DrRKSingaltegh
@urogeek @ResnickMJ Any insight on what was the volume range of cases done in each institute, low end to high end? #urojc

DrRKSingaltegh
Also it should be noted that many were not included as they didn’t out 2 and 5 years questions. (only 30% of RT patients in study) #urojc

DrRKSingaltegh
It is quite possible that many of the men, both RP and RT “excluded” may have lived happily-ever after. We just don’t know. #urojc

dytcmd
@ResnickMJ @loebstacy @drrksingaltegh @urooncmd Future pay models need quality measures, not simply fee for service. QALYs over RVUs #urojc

DrRKSingaltegh
Agree: @dytcmd@ResnickMJ @loebstacy @urooncmd Future pay models need quality measures not simply fee for service. QALYs over RVUs #urojc

dytcmd
@ResnickMJ @urogeek We can suppose “modern” RP results r better. What about RT, what % of men rx by XRT got 3D-CRT v IMRT? Same poss? #urojc

DrHWoo
#urojc MT“@qdtrinh@DrRKSingaltegh @ResnickMJ @urogeek not surprised, Sim to ED rates in Sanda’s JAMA paper, data from 9 acad centers I bel

urogeek
@DrRKSingaltegh but we do…we have bother info as well. Men get used to ED but not bowel or urinary dysfunction #urojc

DrRKSingaltegh
@urogeek Agreed. I was just thinking about those that didn’t do surveys and therefore at least some were fine (70%of RT patients) #urojc

urogeek
@dytcmd @resnickmj respectfully disagree. No evidence that long term Ed or incontinence better with robot. Imrt-maybe.but big maybe. #urojc

urogeek
@qdtrinh @drrksingaltegh @drhwoo @dytcmd @maxinesun @jdsammon hope so. That’s the goal…#urojc

DrRKSingaltegh
@urogeek #urojc in other words they were not part of the study.

urogeek
@DrRKSingaltegh they were. Imputed data using hot deck technique. Imperfect but best we can do #urojc

urogeek
@DrRKSingaltegh roughly 80% response rates are yr 2 and 5, 60% at yr 15. Very good for observational study#urojc

urogeek
@UroOncMD @DrRKSingaltegh thanks Tony… Lol. #urojc

UroOncMD
@urogeek @DrRKSingaltegh You have to take it down to our level at #urojc If you become a regular we might actually receive CME for this

DrRKSingaltegh
@urogeek @UroOncMD #urojc now Dave if you explain Farrell to the #redsox I would be impressed. #bluejays2013

DrRKSingaltegh
@dytcmd @urogeek @resnickmj I was finishing my residency as this study’s yesteryear occurred #timeflies #urojc

MossMateo
@ImaniHolmes1 #urojc GS2 may be AAH, 3-5 is more variable, some could even be 7. Not too relevant to study though …

dopaminergic13
RT @DrHWoo#urojc MT“@dytcmd@urogeek @DrRKSingaltegh @maxinesun @qdtrinh @jdsammon without a doubt. we think we are better at this t …

PeckPreston
@yousefeqk #urojc GS2 may be AAH, 3-5 is more variable, some could even be 7. Not too relevant to study though …

LoebStacy
@DrHWoo @resnickmj @urogeek What about nerve-sparing? #urojc

daviesbj
#urojc Did someone say QUALY?

DrHWoo
@LoebStacy @resnickmj @urogeek Would’ve been int if study stratified for nerve sparing intent – we’re prob all much better at it now #urojc

DrRKSingaltegh
Not sure how much better. The Walsh description came out decade earlier. @DrHWoo @LoebStacy @resnickmj@urogeek #urojc

DrRKSingaltegh
Mid 1990s surgeons thought they were pretty good at nerve sparing. I was there! @DrHWoo @LoebStacy@resnickmj @urogeek #urojc

DrRKSingaltegh
And I guess that is one point of the study. We are never as good as we think we are. @DrHWoo @LoebStacy@resnickmj @urogeek #urojc

DrRKSingaltegh
Also Cavermap, sural nerve grafts, etc. Road littered with good intentions @DrHWoo @LoebStacy @resnickmj@urogeek #urojc

LoebStacy
@DrRKSingaltegh @resnickmj @urogeek What is the 15y rate of #erectiledysfunction in PCOS for preop potent men who had nerve sparing? #urojc

ResnickMJ
@LoebStacy Working on these data now. Should hopefully be forthcoming soon.#urojc

ResnickMJ
@DrRKSingaltegh #urojc Agree completely. Sobering view of population-level functional outcomes. Need to identify at-risk populations.

ResnickMJ
@DrHWoo @LoebStacy @urogeek #urojc Working on thisnow. Will not have “intent” but rather description from operative note. Keep an eye out.

ResnickMJ
@dytcmd @urogeek @ResnickMJ #urojc While tech. improvements in RP and EBRT may incrementally improve outcomes, likely non-differential.

ResnickMJ
@UroOncMD @urogeek @DrRKSingaltegh #urojc I was wondering when the hot-deck method would start trending!

dytcmd
@ResnickMJ @urogeek Unfortunately prob true. So big gap is in identifying pts with risky CaP to justify side effects of any rx. #urojc

ResnickMJ
@cooperberg_ucsf @dytcmd @urogeek #urojc More difficult task is identifying those at high risk for poor funct outcomes and dissatisfaction.

ResnickMJ
@cooperberg_ucsf @dytcmd @urogeek #urojc Completely agree. Question of timing study after introduction of new tech. remains a challenge.

cooperberg_ucsf
@urogeek @drrksingaltegh Which raises point re: only incontinence reported. Irritation sx are often more bother and worse w RT #urojc

cooperberg_ucsf
@urogeek @dytcmd @resnickmj Lots for evidence favors robotics, problem is mostly low quality. Meta-analyses last yr @EUplatinum #urojc

dytcmd
@cooperberg_ucsf @resnickmj @urogeek Yes models exist, but challenge is matching pt goals to level of care. No one size fits all. #urojc

cooperberg_ucsf
My take-aways on #PCOS: prostate cancer tx should be regionalized, period. And every urologist must track his/her own outcomes #urojc

urogeek
@cooperberg_ucsf @dytcmd @ResnickMJ @EUplatinum #urojc MA looks primarily at blood transfusion not PRO. debate is moot. robot dominant now

urogeek
@cooperberg_ucsf @DrRKSingaltegh #urojc critical point. bother included in pcos though. no diff at 15 yrs but rp worse at 2 and 5

cooperberg_ucsf
@urogeek @dytcmd @ResnickMJ @EUplatinum No, these: http://t.co/ymmjSn95 http://t.co/TqqoZ8CQ Meta-analysis always flawed, but… #urojc

cooperberg_ucsf
Do we know the average case volume for urologists w/ pts in PCOS? @urogeek #urojc

urogeek
@cooperberg_ucsf @dytcmd @ResnickMJ @EUplatinum #urojc yeah but the PROs collected in studies in those MAs all problematic

dytcmd
@urogeek @cooperberg_ucsf @resnickmj Prob with PROs is pt told open RP is major surg and accepted “poorer” result. Robo is opposite #urojc

dytcmd
@urogeek @cooperberg_ucsf @resnickmj Non-PROs (pos SM, strictures, secondary procedures) clearly better today, open or robot. #urojc

ResnickMJ
@cooperberg_ucsf @dytcmd @urogeek #urojc One point often neglected is the disutility pts. place on bowel dysfunction http://t.co/RujS3xHi

urogeek
@dytcmd @cooperberg_ucsf @ResnickMJ agree 100%. robot is a “leveler” standardizes op across surgeons….#urojc

urogeek
@cooperberg_ucsf @dytcmd @ResnickMJ @LoebStacy @DrRKSingaltegh @UroOncMD as usual I’m youre number #1 supporter, Matt C. #auaregistry #urojc

urogeek
@cooperberg_ucsf @dytcmd @ResnickMJ #urojc this is the most important comment of them all. risk strat not that hard but goes unused

UroOncologist
Also asst standardized.Almost any PGY, any program – assist well @urogeek@dytcmd @cooperberg_ucsf@ResnickMJ robot is a “leveler”..#urojc

UroOncologist
Not case with open. Need chief level help to be fast and good @urogeek@dytcmd @cooperberg_ucsf@ResnickMJ Robot is “leveler” #urojc

hlianaxk
@uriahhtco #urojc GS2 may be AAH, 3-5 is more variable, some could even be 7. Not too relevant to study though …

iurojc
#urojc Excellent discussion over last 24 hours. Another hour to make any comments. Any concluding comments from authors @resnickmj @urogeek

daviesbj
#urojc thoughts from the king. the banter is ok but disjointed. Questions and responses should be numbered. something to ponder.

DrRKSingaltegh
@cooperberg_ucsf @dytcmd @resnickmj @loebstacy @urooncmd @urogeek Lacking across the board here in Cda too. Combined AUA/CUA effort? #urojc