Monthly Archives: April 2013

April #urojc transcript

#urojc transcript

Healthcare Social Media Transcript

From: Sun Apr 07 12:00:00 PDT 2013
To: Tue Apr 09 15:00:00 PDT 2013
 

Who were the influencers during this time period? #urojc analytics

Connecting the dots in healthcare social mediaHealthcare Conference  – Tweet Chats  –  Healthcare Analytics

What is #urojc?

StorkBrian
RT @iurojc: Reminder to all participating in the forthcoming #urojc to remember to use the hashtag with each and every tweet

StorkBrian
Looking Forward to the Start of #UROJC April Marks Month Six of this Global Discussion Among Urologists @iurojc

iurojc
Welcome to the April #urojc. Paper from the gold journal on 5ARIs in low risk CaP on AS. Do go for the Best Tweet! http://t.co/KMuHIn0uda

iurojc
Again, background paper 1 – the original AS and 5ARI study from @EUplatinum by @UroOncMD et al. http://t.co/kHEyWBykSK #urojc

iurojc
A couple of questions to get you thinking – coming up Again please include #urojc with every tweet (thanks😎)

iurojc
Q1-How does retrospective study design of the April #urojc paper influence results compared to the background papers which includes an RCT?

iurojc
Q2-Results seem consistent and compelling enough but why aren’t urologists prescribing 5ARIs in the real world – or are they? #urojc

iurojc
RT @StorkBrian: Looking Forward to the Start of #UROJC April Marks Month Six of this Global Discussion Among Urologists @iurojc

StorkBrian
RT @iurojc: Welcome to the April #urojc. Paper from the gold journal on 5ARIs in low risk CaP on AS. Do go for the Best Tweet!http://t.co/KMuHIn0uda

StorkBrian
RT @iurojc: Welcome to the April #urojc. Paper from the gold journal on 5ARIs in low risk CaP on AS. Do go for the Best Tweet! http://t. …

iurojc
Btw – discussion can of course be on any aspect of the given paper #urojc Awaiting wisdom of @_TheUrologist_ @KeithKow @DrRKSingaltegh

linton_kate
@iurojc agree compelling, no gl 8-10 and low no of int risk in this study. Useful for BPE-LUTS and AS, chemoprevention? #urojc

StorkBrian
@iurojc Haven’t used 5ARI’s specifically to treat Prostate Cancer but have many patients with LUTS and Prostate Cancer on 5ARI’s #urojc

iurojc
#urojc MT“@KeithKow@_TheUrologist_ @DrRKSingaltegh Int questn affecting everyday management. My thoughts: 1. What affects on QOL?”

iurojc
Tsk tsk #urojc RT“@KeithKow@iurojc @_TheUrologist_ @DrRKSingaltegh 2. What is cost?”

iurojc
#urojc RT“@KeithKow@_TheUrologist_ @DrRKSingaltegh 3. Less anxiety for some patients given they are getting some “active” treatment?”

StorkBrian
#urojc @iurojc Have very few, if any, patients asking for 5ARI’s for treatment of low grade Prostate Cancer

KeithKow
@StorkBrian @iurojc 5-ARI will not make low-risk CaP disappear. If unlikely to progress, why treat with anything? #urojc

DrRKSingaltegh
@KeithKow @iurojc @_TheUrologist_ going out to dinner and will weigh in later #urojc but #3 worth noting

DrRKSingaltegh
@KeithKow @iurojc @_TheUrologist_ we were a Redeem trial site. Enrolling was easy. Early days of AS, felt they were doing something #urojc

uretericbud
large part of the answer to this “why” question is at http://t.co/wgCo868rbt : http://t.co/9gmI5R9bOU #urojc @iurojc

KeithKow
RT @uretericbud: large part of the answer to this “why” question is at http://t.co/wgCo868rbt : http://t.co/9gmI5R9bOU #urojc @iurojc

KeithKow
@DrRKSingaltegh @iurojc @_TheUrologist_ Good benefit for those anxious about “doing nothing.” But what of anxiety RE: high grade dz? #urojc

UroOncMD
@uretericbud @iurojc #urojc Although longer term follow up needed, there hasn’t been an increase in high grade disease with 5ARI on AS.

uretericbud
@UroOncMD @iurojc Yes, but FDA-warning is major “buzz-kill.” #urojc

linton_kate
@KeithKow @iurojc some low risk will progress if men live long enough, we need longer term studies of 5-ARIs and low risk cap? #urojc

LoebStacy
@KeithKow @drrksingaltegh @iurojc @_theurologist_ Less anxiety w/AS is great but no decrease path progression, #falsesenseofsecurity #urojc

UroOncMD
@uretericbud @iurojc #urojc Real world barrier. Agree

KeithKow
@LoebStacy @drrksingaltegh @iurojc @_theurologist_ As usual, I have to agree with by good friend Stacy on this one. #urojc

LoebStacy
@uretericbud @urooncmd @iurojc Agree hard to imagine giving #5ARI for AS w/FDA warning about high-grade disease (plus $, ED risk) #urojc

StorkBrian
@KeithKow You won’t get any argument from me on this one Like 5ARI’s, when appropriate, for LUTS and hair loss:) @iurojc #urojc

UroOncMD
@LoebStacy @uretericbud @iurojc #urojc How ironic though. ED risk versus treatment? Even in the best of hands…

UrologieTwente
RT @iurojc: Again, background paper 1 – the original AS and 5ARI study from @EUplatinum by @UroOncMD et al. http://t.co/kHEyWBykSK #urojc

_TheUrologist_
@UroOncMD @uretericbud @iurojc can’t be a ton in the AS cohort failing to high-risk to begin with; would take large ‘n’ to show diff #urojc

_TheUrologist_
.@iurojc navigate around PCPT/REDUCE caveats by IDing LUTS to Dx BPH; no “prog to high risk CaPr” worry in MTOPS/COMBAT 😉 #urojc

KeithKow
I offer this SIGNED picture of me with #patriots owner Robert Kraft as #urojc prize. Don’t all tweet at once! http://t.co/InDmpygLY3

_TheUrologist_
@iurojc prescient of authors to use 5-ARI for AS in 1998. Mean AUASS at entry was 8.4 (hardly raging BPH). Years ahead of PCPT result #urojc

LoebStacy
@UroOncMD @uretericbud @iurojc #urojc Isn’t reason to do #activesurveillance to delay or avoid side effects,but preserve window for cure?

StorkBrian
@KeithKow Any takers??? Shout out to our Sponsor for this Month @BJUIjournal #urojc @iurojc

StorkBrian
MT @LoebStacy #urojc Isn’t reason to do #activesurveillance to delay or avoid side effects, but preserve window for cure? @iurojc

KeithKow
@StorkBrian @BJUIjournal @iurojc Nope…..my feelings are so hurt! #urojc

KeithKow
@StorkBrian @LoebStacy @iurojc My thoughts exactly: 5-ARIs are not without side effects, with questionable benefit/increased cost. #urojc

LoebStacy
@daviesbj @UroOncMD @uretericbud @iurojc Google “finasteride lawsuit”:>3 million hits. Risky using off-label for CaP. Only indix BPH #urojc

KeithKow
Key to decreasing anxiety for AS pt is good counseling and pt selection. Educate on low risk CaP, and they shouldn’t be anxious. #urojc

daviesbj
@LoebStacy @urooncmd @uretericbud @iurojc ok. Google DaVinci and lawsuit. Lawsuits don’t mean much. I see no risk at all #urojc

matthayn
@UroOncMD @LoebStacy @daviesbj @uretericbud @iurojc Don’t forget about #MEAL study. NO risk in improving diet. #sugarisevil #urojc

LoebStacy
@daviesbj @UroOncMD @uretericbud @iurojc Yes but #robot is FDA approved. Finasteride rejected by FDA for #prostatecancer prevention#urojc

_TheUrologist_
@UroOncMD @LoebStacy @daviesbj @uretericbud agree in concomitant BPH…Q is whether they were bothered re: their LUTS before CaPr Dx#urojc

daviesbj
@UroOncMD @loebstacy @uretericbud I use it commonly for AS. Alex & Stacy work in a litigious enviro maybe they should avoid. #urojc

_TheUrologist_
Do you editorialize PCPT/REDUCE findings when talking 5ARI to pts? I tell them I don’t believe the drugs _cause_ HGCaPr, just find it #urojc

LoebStacy
@KeithKow #urojc Agree pt education is key to reduce anxiety w/AS. Partner support, more biopsy sampling also predicted good QOL in PRIAS

_TheUrologist_
In AS patients, do you guys use failure-to-drop-PSA-by-50% as a Bx indicator (as in some trial pts)? #urojc

StorkBrian
@matthayn Books written on Diet in Prevention of Prostate Cancer. What Dietary Resources do You Recommend to Patients w P.C.? #urojc

uretericbud
@_TheUrologist_ #urojc Agree — FDA warning largely alarmist. Contextualizing risk is key. For LUTS and large gland, still a good drug.

StorkBrian
@matthayn Thank you! I’ll pass this along to my patients #urojc @memedicalcenter

DrRKSingaltegh
Nice MT @KeithKow: Offering SIGNED picture with #patriots owner Robert Kraft as #urojc prize.Don’t all tweet at once! http://t.co/t75ZxXxAt3

DrRKSingaltegh
And if they have symptoms it makes it even easier @LoebStacy @UroOncMD @uretericbud @iurojc #urojc

DrRKSingaltegh
@LoebStacy @uretericbud @urooncmd @iurojc That FDA warning has done more harm than good. Thesepatients low risk and actively followed#urojc

DrRKSingaltegh
@KeithKow @StorkBrian @BJUIjournal @iurojc I thought it was nice! #urojc

DrRKSingaltegh
Lawsuits less of an issue in Canada. I don’t see the risk with good counselling @LoebStacy @daviesbj @UroOncMD @uretericbud @iurojc #urojc

_TheUrologist_
Re QOL/anxiety in 5ARI & AS: many may feel heartened to be on “some treatment”; others will panic if PSA doesn’t drop as suggested? #urojc

DrRKSingaltegh
He speaks soothe: RT @daviesbj@LoebStacy @urooncmd @uretericbud @iurojc ok. Google DaVinci/lawsuit. nor much I see no risk at all #urojc

DrRKSingaltegh
@LoebStacy @daviesbj @UroOncMD @uretericbud @iurojc Again, FDA rejection single-handedly undid a lot of potential good #urojc

DrRKSingaltegh
@LoebStacy @daviesbj @UroOncMD @uretericbud @iurojc It has caused many to not use the drug at all , ignoring decent evidence #urojc

LoebStacy
@_TheUrologist_ @UroOncMD Etzioni prev studies showed multiplication factor changes over time, and PSAV>0 on 5ARI= cause for concern#urojc

DrRKSingaltegh
@_TheUrologist_ I say the same as well. Usually i add that this has been the canadian consensus #urojc makes my dictated notes extra long

DrRKSingaltegh
Cdn View re 5ARI use postFDA Reasonable in my view @UroOncMD was there via @CanUrolAssoc cc @ProstateCancerC #urojchttp://t.co/v73bX8jqHh

uretericbud
@daviesbj @UroOncMD #urojc GU docs were also doing prostate massage for yrs. primum non nocere (albeit we agree more than disagree on this)

DrRKSingaltegh
@ProstateCancerC @MovemberCA & other advocacy groups: please follow #urojc discussion next 48 hrs AS & 5ARI use #hcsmca#prostatecancer

njtouma
@uretericbud @_theurologist_ I agree: big glands + LUTS only indication in context of low risk CaP #urojc

_TheUrologist_
Litigation etc aside, is evidence from REDEEM and this paper good enough to justify standard use of 5ARIs? #urojc

Tdave
Or are we just using this to offer “something” to these patients. Minimal hurt w ? benefit #urojc

iurojc
Tsk tsk #urojc MT“@UroOncMD@LoebStacy @uretericbud Keep men on AS by w/ 5ARI keeps them out of o.r., even if sl higher ED than placebo”

_TheUrologist_
Also, should we really think that the 1-core G6 gland is so different from the negative/unBx prostate that PCPT/REDUCE don’t apply? #urojc

DrRKSingaltegh
Great, hashtag 2 follow is #urojc RT @MovemberCA@DrRKSingaltegh @ProstateCancerC thanks for giving us heads up! We’ll be following along.

roccorossiTO
RT @DrRKSingaltegh: Great, hashtag 2 follow is #urojc RT @MovemberCA@DrRKSingaltegh @ProstateCancerC thanks for giving us heads up! We …

_TheUrologist_
@njtouma @uretericbud indeed, must use same LUTS/BPH Tx triggers in AS pop’n as we would in non-Ca pop’n #urojc

_TheUrologist_
RT @DrRKSingaltegh@ProstateCancerC @MovemberCA & other advocacy groups: please follow #urojc discussion next 48 hrs AS & 5ARI …

Tdave
PS is this the international cancer journal club? Can we do non cancer next month? Or will yinzers not have anything to tweet? #urojc

daviesbj
@uretericbud @urooncmd don’t forget female urethral dilation #urojc I still see women who demand it

daviesbj
#urojc reminder that @LoebStacy is recovering from final four emotional issues. Watch out !!

_TheUrologist_
MT @ChristophFrench: repeat bx planned in 18m, but will move it ahead if psa doesnt fall by 6 mo. Like @UroOncMD have done a few mri. #urojc

roccorossiTO
RT @iurojc: Tsk tsk #urojc MT“@UroOncMD@LoebStacy @uretericbud Keep men on AS by w/ 5ARI keeps them out of o.r., even if sl higher ED …

_TheUrologist_
@LoebStacy @UroOncMD cancer-destined pts in REDUCE had PSA rise from baseline #urojc

_TheUrologist_
.@LoebStacy @UroOncMD also PSA decr is a range around 50% so automatic doubling in the clinician’s mind could be “doubly” inaccurate #urojc

LoebStacy
@daviesbj #urojc I’m very proud of my team for making #finalfour (plus I’m on beach in Cancun) so life is good 🙂 http://t.co/eu9l0hXyzR

_TheUrologist_
@njtouma @uretericbud @UroOncMD buy a pill cutter and give ’em 12.5mg casodex 😉 #urojc

daviesbj
RT @LoebStacy@daviesbj #urojc I’m very proud of my team for making #finalfour (plus I’m on beach in Cancun) so life is good 🙂http://t.co/eu9l0hXyzR

_TheUrologist_
Welcome Canadian/Newfoundland uro @ChristophFrench to #urojc discussion! CDN CaPr leader @siemensr is out there somewhere too…

DrRKSingaltegh
This endourologist will be there MT @Tdave: Can we do non cancer next month? Or will yinzers not have anything to tweet? #urojc

DrRKSingaltegh
+1MT @ChristophFrench@_TheUrologist_ repeat bx 18mo,move it ahead if psa doesnt fall by 6 mo. Like @UroOncMD have done a few mri.#urojc

daviesbj
Nerd Alert MT @DrRKSingaltegh: This endourologist will be there MT @Tdave: Can we do non cancer next month? #urojc

nickbrookMD
#urojc interesting that ave psa reduction approx 50% but ave prostate vol reduction only 19%. Alters utility of psad for a given prostate.

nickbrookMD
@iurojc misguided concern re incr risk of HG CaP with 5ARI seems a reason for low use among urols. Also ED but only 2% dropout here #urojc

declangmurphy
@_TheUrologist_ #urojc Absolutely not. Seriously, would anyone use 5ARIs as chemoprevention or for AS?? No bloody way. No game-changer here

_TheUrologist_
.@declangmurphy lobs a grenade into #urojc Tell us what you really think, Dr. M!

DrHWoo
@declangmurphy @_TheUrologist Declan, is your objection the high grade cancer, side effects or lack of efficacy? #urojc

declangmurphy
@DrHWoo All of the above! Might as well do focal therapy #godhelpus #urojc

nickbrookMD
@declangmurphy no gamechanger but tidechanger. 1% HG CaP many studies means no concern 5ARIs 4 LUTS. Future uses?? watch this space#urojc

lihmingwong
@declangmurphy @_TheUrologist_ #urojc #REDEEM weakened by composite end point of “progression” (path + Rx) and failure to blind PSAs

KeithKow
@_TheUrologist_ I counsel on risk, but only use for BPH pts. Tell them they all get screened anyways, so shouldn’t worry. #urojc

KeithKow
public service announcement, and potential article for next #urojc: Fournier’s after masturbation in healthy 29yo! http://t.co/Mke96AzRrl

DrRKSingaltegh
@declangmurphy @_TheUrologist_ @DrHWoo #urojc Agreed but isn’t everything we do about building a case?

DrRKSingaltegh
@declangmurphy @_TheUrologist_ #urojc @DrHWoo bph patient with a strong FamHx often adds to the rationale. Extra possible benefit, close FU

LoebStacy
@declangmurphy @daviesbj Not quite…Lecturing on #activesurveillance at Mexican Urologic @colmexurologia this week so #urojc very timely

DrHWoo
Totally agree RT @nickbrookMD: misguided concern re incr risk of HG CaP – 5ARI seems a reason for low use among urols. #urojc

DrHWoo
@declangmurphy I treat v low risk CaP (as per study) as if didn’t have CaP when comes to LUTS – safety issues wrt HG ca overstated #urojc

nickbrookMD
@DrRKSingaltegh have occ used for large bph with high psa repeated neg biopsies (incl TP) to reduce sympt & incr future biopsy sens #urojc

declangmurphy
@DrHWoo Good plan. Conclusion – use 5ARIs for BPH LUTS only. Role in cancer is #muddywater. Steer clear. #urojc

urorao
@declangmurphy #urojc Declan has hit the nail on the head. I DARE ASK, hav the authors of PCPT&REDUCE trial themselves taking 5ARIs?#notme

urorao
@daviesbj #urojc UD still a good operation. No evidence base but a strong placebo base. Agree many women demand it on a regular basis!

declangmurphy
@nickbrookMD Agree Nick. Treat LUTS BPH on its merits; assess ca risk independently. Don’t think 5ARIs either cause or treat cancer #urojc

iurojc
To what extent does sexual dysfunction dissuade urologists from offering 5ARIs for men with low grade cancer on AS? #urojc

iurojc
Three studies suggest benefit of 5ARIs for men on active surveillance. ED – natural history vs S/E of 5ARIs vs S/E of surgery/RT? #urojc

iurojc
Q3 – To what extent does sexual dysfunction dissuade urologists from offering 5ARIs for men with low grade cancer on AS? #urojc

iurojc
Q4 – Three studies suggest benefit of 5ARIs for men on active surveillance. ED – nat history vs S/E of 5ARIs vs S/E of surgery/RT? #urojc

nickbrookMD
@declangmurphy on the same page. BUT 2 randomx studies show large reduction in CaP diagnosis with 5ARI so they may have another use#urojc

iurojc
RT @urorao@declangmurphy #urojc Declan has hit the nail on the head. I DARE ASK, hav the authors of PCPT&REDUCE trial themselves t …

iurojc
RT @declangmurphy@DrHWoo Good plan. Conclusion – use 5ARIs for BPH LUTS only. Role in cancer is #muddywater. Steer clear. #urojc

brookmanknight
RT @declangmurphy@DrHWoo Good plan. Conclusion – use 5ARIs for BPH LUTS only. Role in cancer is #muddywater. Steer clear. #urojc

iurojc
Tsk tsk #urojc RT “@daviesbj@UroOncMD @uretericbud disagree. Alex is being alarmist. GU docs giving these drugs for years without problem

declangmurphy
@nickbrookMD F/up of RCTs short. Uncertain what impact long term 5ARI (“mini-ADT”) has on nat hx in these studies. Pharma won’t fund #urojc

JGrummet
Currently accruing RCT on ED from 5ARIs. Suspect much higher incidence than prev quoted. Major deterrent to prescribing in sex active #urojc

nickbrookMD
@declangmurphy point well made Declan. 5ARI contentious issue in urology 2nd only to PSA screening #urojc

iurojc
RT @nickbrookMD@declangmurphy point well made Declan. 5ARI contentious issue in urology 2nd only to PSA screening #urojc

iurojc
@ArunkumarDr Great to have you join the discussion – if you use the #urojc hashtag in all tweets, all participants will then see your tweet.

iurojc
#urojc MT“@ArunkumarDr: In India physicians give 5ARIs routinely in treating BPH irresp of size. Easily avail as combo pack with alpha blkrs

linton_kate
@iurojc men on AS trying to avoid SE’ s so may not be keen on ED risk, however risk of ED on AS, if have LUTS can justify #urojc

iurojc
@imnormgoh Looking forward to your input in the #urojc discussion! Would love to have SE Asia input!

roccorossiTO
RT @iurojc: Tsk tsk #urojc RT “@daviesbj@UroOncMD @uretericbud disagree. Alex is being alarmist. GU docs giving these drugs for years …

roccorossiTO
RT @iurojc#urojc MT“@ArunkumarDr: In India physicians give 5ARIs routinely in treating BPH irresp of size. Easily avail as combo pack …

Ben_L_Jackson
How will 5ARIs affect AS in the future? Studies describe PSA/std Bx based f/u but what about protocols including mpMRI/template Bx? #urojc

DrHWoo
@JGrummet Existing ED common in this age group & even greater prevalence with increasing LUTS. For many men, these S/E not issue. #urojc

linton_kate
@Ben_L_Jackson @iurojc if you look harder for cap you will find it, maybe the effect of 5-ARI will be less? #urojc

JGrummet
@DrHWoo #urojc no probs if older & not sex active, but last thing you want to give active pts with ED is risk of worsening with a 5ARI.

Ben_L_Jackson
@linton_kate @iurojc yep. “benefits” of 5ARIs in AS may disappear as we start to detect/monitor actual cancer burden more accurately #urojc

CMCuro
@iurojc Authors of the Gold Journal paper checking in! Any questions for us we’ll be pleased to answer, otherwise will join in #urojc

iurojc
@CMCuro Big welcome to April #urojc authors – please do look back over the disc so far & look forward to comments http://t.co/QPWPIHZrWc

DrHWoo
RT @iurojc@CMCuro Big welcome to April #urojc authors – please do look back over the disc so far & look forward to comments http:/ …

DrHWoo
@Ben_L_Jackson @linton_kate Long term data impt to clarify. Will this be possible @UroOncMD @cmcuro? Have no expectations 4 REDEEM#urojc

DrHWoo
@UroOncMD Excellent Tony. We are counting on you & @CMCuro for this type of data. REDEEM was GSK funded. @Ben_L_Jackson@linton_kate #urojc

DrHWoo
#urojc RT @Ben_L_Jackson @linton_kate @CMCuro There’ll be no f/u REDEEM data. However our updated series to be reviewed shortly has 6 y f/u

nickbrookMD
@CMCuro interested 2 hear ur thoughts on 50% reduc in PSA but only 19% vol reduction. Gr8 paper lots of good discussion so far #urojc

DrRKSingaltegh
But better for larger prostates. PSA of at least 1.5 seems like good surrogate of that @ArunkumarDr @iurojc #urojc

LoebStacy
@_TheUrologist_ @urooncmd #urojc Agree #5ARI PSA effects time-varying. Multiply by 2 for 1st 3y, then 2.3, then 2.5 at >6y. Bx if PSAV>0

DrRKSingaltegh
BIGGEST problem with 5ARI use? By far, having patient on the drug on referral with no baseline PSA EVER done. I see this issue daily #urojc

StorkBrian
@DrRunz_Urology Any Thoughts on the Current #urojc discussion about 5ARIs and Prostate Cancer?

DrRKSingaltegh
RT @LoebStacy@_TheUrologist_ @urooncmd #urojc Agree #5ARI PSA effects time-varying. Multiply by 2 for 1st 3y, then 2.3, then 2.5 at &g …

DrRKSingaltegh
Issue with all drug-sponsored trial. Funded 4 finite time, supposed 2extrapolate forever @DrHWoo @Ben_L_Jackson @linton_kate @CMCuro#urojc

LoebStacy
@UroOncMD @drhwoo @ben_l_jackson @linton_kate @cmcuro #urojc REDEEM only 3y f/u but prior reports w/increase high-grade were after >3-4y use

DrHWoo
Also hoping to hear from @uropro expertise MT@StorkBrian@DrRunz_Urology Any Thoughts on discussion about 5ARIs & Prostate Cancer?#urojc

DrHWoo
@LoebStacy @_theurologist_ @urooncmd Agree impt urologists know 5ARI doubling rule limitation. Rise above PSA nadir better guide. #urojc

HugoHDavila
RT @iurojc@CMCuro Big welcome to April #urojc authors – please do look back over the disc so far & look forward to comments http:/ …

CMCuro
@nickbrookMD Anecdotally, seems larger glands tend to shrink 25-30% but smaller glands less. 50% PSA drop/25% vol. reduction common #urojc

CMCuro
@iurojc Any thoughts on the role of lifestyle changes in AS for PCa? http://t.co/omMBO8jaDP #urojc

HugoHDavila
RT @nickbrookMD@declangmurphy point well made Declan. 5ARI contentious issue in urology 2nd only to PSA screening #urojc

HugoHDavila
#urojc AS= monitoring the course of disease with the expectation to intervene and cure. Are we proposing AS with treatment? So is not AS

CMCuro
@_TheUrologist_ In our study, repeat bx’s for poor PSA response seemed to find more PCa and more aggressive PCa #urojc

iurojc
RT“@CMCuro@iurojc Any thoughts on the role of lifestyle changes in AS for PCa? http://t.co/H0jhpHte7f #urojc

StorkBrian
@iurojc @cmcuro Think we could All Benefit from Diet and Lifestyle Changes +/- Prostate Cancer #urojc

StorkBrian
@iurojc @cmcuro Think we could All Benefit from Diet and Lifestyle Changes +/- Prostate Cancer #urojc

matthayn
Not much to think about. Good idea. Should be offered to every PCA patient, regardless of treatment. @iurojc @cmcuro @StorkBrian #urojc

oussama_elhage
@matthayn @iurojc @cmcuro @storkbrian I would be worried about the increased risk of heart failure! #urojc

LoebStacy
@matthayn @iurojc @cmcuro @storkbrian #urojc agree- studies show s/p CaP dx many concur w/favorable lifestyle changes. Lower competing risks

oussama_elhage
#urojc @iurojc are we getting worked up by a retrospective, no randomised study of 82 patients. Low evidence. Keep calm and carry on!

oussama_elhage
#urojc @iurojc are we getting worked up by a retrospective, no randomised study of 82 patients. Low evidence. Keep calm and carry on!

iurojc
@oussama_elhage Well done – best to consider this paper in context of REDEEM and @UroOncMD studies. Studies like these stir disc #urojc

iThangasamy
@storkbrian @iurojc #urojc (better late than never)

iThangasamy
@StorkBrian @iurojc #urojc What do you tell these patients about 5ARIs? To treat LUTS or…

iThangasamy
#urojc MT “@KeithKow@iurojc if benefit questionable…why increase cost? Of course if known benefit, cost should be irrelevent.”

StorkBrian
@iThangasamy Welcome back Glad to hear you are on the mend! @iurojc #urojc

StorkBrian
@iThangasamy Welcome back Glad to hear you are on the mend! @iurojc #urojc

iThangasamy
@StorkBrian @keithkow @iurojc haha ok this answers my previous question. Good to hear about practice habits outside of local centres #urojc

iThangasamy
@ArunkumarDr @iurojc #urojc In the setting of CaP? I can imagine no shortage of patients for trials..

iThangasamy
@ArunkumarDr @iurojc #urojc In the setting of CaP? I can imagine no shortage of patients for trials..

StorkBrian
@HendrikBorgmann Like 2 invite you to join our monthly, Global #urojc discussion about the use of 5ARIs going on right now @iurojc @DrHWoo

iThangasamy
RT @LoebStacy@KeithKow #urojc Agree pt education is key to reduce anxiety w/AS. Partner support, more biopsy sampling also predicted g …

HendrikBorgmann
#urojc exercise and smoking are modifiable lifestyle factors influencing PSA levels of PCA patients undergoing AS http://t.co/DEE5BJfP0c

Tdave
RT @KeithKow: public service announcement, and potential article for next #urojc: Fournier’s after masturbation in healthy 29yo!http://t.co/Mke96AzRrl

HugoHDavila
#urojc AS=is monitoring the course of the disease with the expectation to intervene and cure.Are we proposing AS with treatment?So is not AS

iurojc
RT @LoebStacy@_TheUrologist_ @urooncmd #urojc Agree #5ARI PSA effects time-varying. Multiply by 2 for 1st 3y, then 2.3, then 2.5 at &g …

iurojc
Q5- is the effect of 5ARIs on low grade CaP just mild form of ADT masking true behavior/natural history of the cancer? #urojc

DrRKSingaltegh
Combat trial for BPH: via @EUplatinum Don’t forget the main reason for 5 ARI use. They are good drugs #urojc http://t.co/UJSQI5ILPI

DrRKSingaltegh
+1 MT @iurojc@oussama_elhage Best to consider this paper in context of REDEEM and @UroOncMD studies. Studies like these stir disc #urojc

DrRKSingaltegh
And it gives patients an sense of active participation in disease management #urojc @LoebStacy @matthayn @iurojc @cmcuro @storkbrian

iurojc
Q6- Case: 65 yrs on AS 3 yrs- 2/24 cores GS6 on rpt sat biopsies, IPSS 9/3, SHIM 19, 110cc gland, neg mpMRI but rising PSA? #urojc

DrRKSingaltegh
Modifying factors MT @HendrikBorgmann #urojc exercise & smoking influence PSA levels of PCA patients undergoing AS http://t.co/SVdZS1lmgA

urorao
@iurojc #urojc Sat Bx in a 110cc may have missed anterior tumour! agree mpMRI may be negative, still mpMRI not sensitive enough #templateBx

iurojc
Case cont -Would @CMCuro @UroOncMD give 5ARIs? Or only if TP template biopsy negative? #urojc

iurojc
RT @urorao@iurojc #urojc Sat Bx in a 110cc may have missed anterior tumour! agree mpMRI may be negative, still mpMRI not sensitive eno …

StorkBrian
@iurojc #urojc Heard a lot from the Former Colonies this Month but where are the British? @BJUIjournal @prokarurol

iurojc
@StorkBrian Always good to rustle up the Brits for #urojc @prokarurol @MattBultitude @JimCatto @benchallacombe Hon mention to @urorao

UrologieTwente
RT @LoebStacy@_TheUrologist_ @urooncmd #urojc Agree #5ARI PSA effects time-varying. Multiply by 2 for 1st 3y, then 2.3, then 2.5 at &g …

benchallacombe
@iurojc #urojc I use 5ARIs if -ve mri & transperineal bx & luts. Not to impact on ca risk but worrying if psa doesn’t fall.

urorao
@iurojc #urojc Even if Rx with 5ARIs, 38% chance of pathol progression of cancer. Large BPH-5ARIs – size reduction by ~20% #heading2RP

urorao
#urojc good “expert insight” abt drawbacks of REDEEM Reduction in PSA = unblinding of trialists = bias in treatment http://t.co/CqE6kjWGmj

DrHWoo
@urorao Caution with decision to intervene with RP on PSA rise- not great performer predicting prog on AS. This case- BPH driving PSA #urojc

cooperberg_ucsf
@DrRKSingaltegh @UroOncMD @CanUrolAssoc @ProstateCancerC Again Canada proves more savvy than the US (PSA comes to mind too)#OCanada #urojc

daviesbj
@uretericbud @cooperberg_ucsf coops is 24hrs off topic. Did the baby come? #urojc

cooperberg_ucsf
@iurojc I think this is asked & answered by Thompson & co: #urojc (this was the interpretation the FDA rejected) http://t.co/maBZTPGyUw

StorkBrian
@iurojc #urojc What is the Best Tweet Prize this Month? #hopingforknighthood @BJUIjournal

StorkBrian
@DrHWoo @iurojc Just used Google Translator – Not Bad Might make it possible to expand #urojc to multi language discussion @BJUIjournal

StorkBrian
Google Translation Invitamos a todos los urólogos de habla hispana a unirse a nuestra discusión #urojc @iurojc

iThangasamy
RT @declangmurphy@DrHWoo Good plan. Conclusion – use 5ARIs for BPH LUTS only. Role in cancer is #muddywater. Steer clear. #urojc

iThangasamy
@declangmurphy @drhwoo #urojc I’ve been looking for ‘concluding’ statement with all this FDA talk. But seems some int. colleagues disagree

iThangasamy
RT @DrHWoo: Totally agree RT @nickbrookMD: misguided concern re incr risk of HG CaP – 5ARI seems a reason for low use among urols.#urojc

iThangasamy
RT @nickbrookMD@declangmurphy point well made Declan. 5ARI contentious issue in urology 2nd only to PSA screening #urojc

iThangasamy
RT @urorao#urojc good “expert insight” abt drawbacks of REDEEM Reduction in PSA = unblinding of trialists = bias in treatment http:/ …

DrHWoo
Study design apart from volume artefact might explain why increased HG CaP found in REDUCE study c/o @uropro #urojc http://t.co/9Rd9pk1FVj

iThangasamy
RT @cooperberg_ucsf: . @iurojc I think this is asked & answered by Thompson & co: #urojc (this was the interpretation the FDA re …

UrologyMatch
MT“@cooperberg_ucsf: . @iurojc #urojc (this was the interpretation the FDA rejected) http://t.co/J3JjQup6jJ”

UrologyMatch
@declangmurphy@DrHWoo Good plan. Conclusion – use 5ARIs for BPH LUTS only. Role in cancer is #muddywater. Steer clear. #urojc

iurojc
Tsk tsk #urojc 😎MT“@DrRunz_Urology: PCA3 at time diagnosis and PSA rise may help with Pca volume. 5ARI on large pros & AS good for PSAveloc

DrHWoo
Awaiting our European colleagues to awake & join discussion. @joddens @urorich @odoktero @MRyanBalken @urobart @Dr_Geb @dmsomford#urojc

DrRKSingaltegh
Thanks Matt @cooperberg_ucsf @UroOncMD @CanUrolAssoc @ProstateCancerC #urojc

DrRKSingaltegh
Look forward to their comments when i awaken Goodnight @DrHWoo @joddens @urorich @odoktero @MRyanBalken @urobart @Dr_Geb@dmsomford #urojc

DrRKSingaltegh
BPHwithLUTS, Large prostates, possibly motivated patients with FamHx, low risk CaP& treat theBPH @iThangasamy @declangmurphy @drhwoo#urojc

nickbrookMD
@rsinghrai time for an avatar on twitter… and make sure you follow #urojc next month with @iurojc. followed last 2.. have been great

DrRKSingaltegh
@nickbrookMD @rsinghrai @iurojc Not too late. 31 participants so far. Let’s get to 40+ by tomorrow #urojc

iurojc
RT @DrRKSingaltegh@nickbrookMD @rsinghrai @iurojc Not too late. 31 participants so far. Let’s get to 40+ by tomorrow #urojc

iThangasamy
Definitely! RT“@DrRKSingaltegh@nickbrookMD @rsinghrai @iurojc Not too late. 31 participants so far. Let’s get to 40+ by tomorrow #urojc

iThangasamy
Just over 12 hours to go for #urojc discussion on use of 5ARIs for low risk CaP AS. Rounding off 6 months of @iurojc Trainees get onboard!

BJUIjournal
RT @iThangasamy: Just over 12 hours to go for #urojc discussion on use of 5ARIs for low risk CaP AS. Rounding off 6 months of @iurojc Tr …

Ben_L_Jackson
@iThangasamy @iurojc agreed, would be great to see a few more trainees. Anyone following #urojc , tweet to let us know you’re out there!

DrHelenF
Post reading of @iurojc and REDEEM is the use of 5ARIs for low risk CaP AS provided as an option in ‘real life’ clinical practice? #urojc

DrHWoo
@DrHelenF 5ARIs def have place for LUTS Mx of men on AS. for ⬇progression, F/U of 3 yrs is issue in spite of 3 compelling studies. #urojc

iThangasamy
RT @Ben_L_Jackson@iThangasamy @iurojc agreed, would be great to see a few more trainees. Anyone following #urojc , tweet to let us kno …

iThangasamy
@DrHWoo @drhelenf Already mainstay treatment for LUTS but some data to suggest risk of high grade CaP progression hence FDA rejection#urojc

oussama_elhage
@Ben_L_Jackson @ithangasamy @iurojc great forum for trainees to get involved in #urojc @kahmed198 @jonmakUrology

DrHWoo
@iThangasamy @DrHelenF In spite FDA reject, risk of HG CaP prob artefact of vol & study design and not real. http://t.co/9Rd9pk1FVj #urojc

KellieWest9
70% continued to have low-grade Ca on 3 yr f/u but that still leaves 30%. Given 1/3 pts decline f/u biopsy is AS risky? #urojc

DrRKSingaltegh
@KellieWest9 Declining biopsy on AS cannot be tolerated. With proper counselling patients need to regard AS as Rx. FU Bx part of Rx #urojc

DrRKSingaltegh
@Ben_L_Jackson and @IsaacThangasamy are veterans. All else join in! @oussama_elhage @iurojc @kahmed198 @jonmakUrology #urojc

iThangasamy
@DrRKSingaltegh @ben_l_jackson @oussama_elhage @iurojc @kahmed198 @jonmakurology Ha! Good one 😉 No seriously we learn lots through #urojc

LoebStacy
@cooperberg_ucsf @iurojc Walsh reply: 5ARIs are weak form of hormonal therapy–>can cause minimal regression of low vol,low grade dz #urojc

LoebStacy
@cooperberg_ucsf @iurojc Walsh cont.: ‘#5ARIs are not effective in suppressing higher grade tumors & actually have agonistic effect’ #urojc

Ben_L_Jackson
@iThangasamy @drrksingaltegh @oussama_elhage @iurojc @kahmed198 @jonmakurology Friendly forum too, easy to participate freely #urojc

DrHLN
But clinically men w/ LUTS & low vol/grade Ca on AS may use 5ARIs for BPH if counselled re theoretical ca risk & compliant w/ bx? #urojc

DrHLN
And yes, slightly disconcerting for trainees as some international voices of experience but invaluable learning tool #urojc

iurojc
Just under an hour to go. Any final thoughts. #urojc

iThangasamy
@iurojc It’s been an illuminating discussion worthy of rounding off 6mths of #urojc Great paper selection and excellent learning opportunity

HendrikBorgmann
French Association of Urology:no recommendation for 5ARI concerning PCA http://t.co/OkInI1gkiJ #urojc What do other associations recommend?

DrRKSingaltegh
i will attach Cdn 5ARI guidelines again http://t.co/v73bX8jqHh MT @HendrikBorgmann: French Uro:no recommendation for 5ARI and CaP #urojc

AmandaSJChung
@iurojc #urojc New to urojc and discovering this is a great educational tool for trainees. Thanks to all.

DrRKSingaltegh
Jump in RT @AmandaSJChung@iurojc #urojc New to urojc and discovering this is a great educational tool for trainees. Thanks to all.