Author Archives: Henry Woo

About Henry Woo

Associate Professor of Surgery, Sydney Adventist Hospital Clinical School, University of Sydney. Urological surgeon specialising in prostate surgery.

June #urojc Transcript

Healthcare Social Media Transcript

From: Sun Jun 02 13:00:00 PDT 2013
To: Tue Jun 04 15:00:00 PDT 2013

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

Healthcare Conference  – Healthcare Tweet Chats  –  Healthcare Analytics

StorkBrian
@DrRunz_Urology Cris, were are talking about stones this month @iurojc #urojc Love to have you join in the conversation

iurojc
Welcome to the June #urojc discussion. Starts now & runs for 48 hours. Paper is available on line as free download http://t.co/QcwJRn0zto

LoebStacy
New research showing 26% decreased risk of #kidney stones w/ 1 or more servings #coffee per day! Off to @Starbucks #thankgod #addict #urojc

iurojc
June #urojc article is open access http://t.co/QcwJRn0zto thanks to #CJASN Lead author @FerraroManuel will be joining us for the discussion

iurojc
Don’t forget to include the hashtag with every discussion tweet in order for everybody to see. #urojc

iurojc
It’s @AustProstate. MT “@StorkBrian@DrHWoo Anyone know the Twitter Handle for Aust Prostate Ca Research? #urojc” Ping @declangmurphy

iurojc
Q1. Are these results applicable to your patient population? What about for your existing stone formers? #urojc

iurojc
Q2. How can we account for influence of overall fluid consumption? Is this an important consideration? #urojc

Tdave
Soda, cola: bad. Coffee, beer & wine: good. I like this paper! #urojc

DrHWoo
@DrAdamMurphy @LoebStacy Could it be the diuretic action. Cups of coffee in the US are huge+. Real coffee when you come to Melbourne. #urojc

Tdave
But what exactly is “punch” and why so bad? Who is drinking this exactly? #urojc

iurojc
@DrAdamMurphy Do join us for current discussion on stones. Follow the hashtag #urojc

CBayneMD
@iurojc fluid consumption extremely important to consider in stone papers as it is only variable in RCT to sig impact stone formation #urojc

LoebStacy
New study shows 1 or more sugar-sweetened cola/day increases #kidney #stone risk by 23% #urojc Attn @MikeBloomberg @jwgale #nyc #sodaban

JZanetti11
RT @LoebStacy: New study shows 1 or more sugar-sweetened cola/day increases #kidney #stone risk by 23% #urojc Attn @MikeBloomberg @jwgale #…

DrHWoo
@Tdave I always thought of fruit punch being a home made concoction & usually laced with plenty of ETOH. Is it a defined drink? #urojc

Tdave
@DrHWoo Maybe Kool-Aid type drink? Unknown, but clearly evil! #urojc

DrHWoo
@LoebStacy @MikeBloomberg @jwgale Authors postulate it’s the fructose that is the issue with kidney stone http://t.co/LAL6KsDIXC #urojc

MattBultitude
@DrHWoo @Tdave – Quite important to know the definition of punch – should have been in the paper. Can authors please clarify for us ? #urojc

linton_kate
@iurojc looks like we need to relocate stone clinic to the dental hospital as patients likely need dental and urology input #urojc

daviesbj
Just wanted to say hi. Nothing to add #urojc I love fruit punch btw (with gin) #deepdaviesthoughts

MattBultitude
I tell patients diet 7-up/ sprite/ sunkist are best fizzy drinks. This supports that but still shows increase risk. Better than colas #urojc

iurojc
Up for grabs is a chance to join King @daviesbj in Hall of Fame for best discussion tweet – best tweet prize thanks to @EUplatinum #urojc

iurojc
Lets not forget the #urojc hashtag MT“@DrAdamMurphy@DrHWoo @LoebStacy ……..It has been postulated to be the diuretic action”

LoebStacy
#urojc Sound byte: Not all liquids are equal w/respect to #kidneystones. Avoid sugar soda/punch. Wine/coffee/tea good. @sosa_ernie comment?

MattBultitude
What do we think of methodology? Large cohort studies. Enrolled 1976, ’86, ’89. All male HCP’s or female nurses. Prone to dehydration?#urojc

DrHWoo
Mostly Caucasian as well! MT“@MattBultitude: ……Enrolled 1976, ’86, ’89. All male HCP’s or female nurses. Prone to dehydration?#urojc

_TheUrologist_
.@Tdave drinking “punch” means you live in 1870s London and are going to pus out of Petit’s triangle #urojc

_TheUrologist_
@MattBultitude wondered about overlap of high sugary drink consumption and sedentary/Ca++ mobilizing lifestyle. Less likely in HCPs #urojc

DrAdamMurphy
@LoebStacy @sosa_ernie The relationship may not be linear. At least modest coffee intake is ok. High levels could be bad #urojc.

DrHWoo
Tweeps, we are discussing a fascinating paper on what drinks ⬆or⬇ your risk of kidney stones on the hashtag #urojc http://t.co/XIWWGUSY3G

DrHWoo
@DrAdamMurphy @LoebStacy No worries Adam, we totally for that! Please do join in on #urojc http://t.co/XIWWGUSY3G

iurojc
Currently discussion on what drinks ⬆or⬇kidney stones. http://t.co/QcwJRn0zto #hcsm #hcsmanz #meded #urojc #foamed #coffee #kidneystones

UroOncologist
Scotch needs to be tested. @daviesbj @matthayn @Tdave: Soda, cola: bad. Coffee, beer & wine: good. I like this paper! #urojc

StorkBrian
RT @iurojc: Currently discussion on what drinks ⬆or⬇kidney stones. http://t.co/QcwJRn0zto #hcsm #hcsmanz #meded #urojc #foamed #coffee #ki

StorkBrian
@iurojc Muskegon, MI is also known as “The Beer Tent Capitol of the World” *We See A Lot of Obese Patients* http://t.co/Iea4U09IAh #urojc

captfun99
@iurojc #urojc Dietary sodium consumption and Controlling for caffeine levels in diet or sugar sodas omitted. Confounders?

Tdave
@UroOncologist @daviesbj @matthayn #Bourbon medicinal properties will clearly be protective #urojc

iurojc
Look forward to input from primary author @FerraroManuel when he wakes up – currently 0200 in Rome! #urojc Please make him welcome!

iurojc
#urojc RT“@hardy_bm@DrHWoo also, thanks for that link to the Harvard study. I can’t even comprehend the logistics of 100k participants!”

iurojc
Insightful #urojc RT“@hardy_bm@DrHWoo does the diuretic effect of the caffeine in energy drinks make up for the stone-forming potential?”

hardy_bm
RT @DrHWoo: Tweeps, we are discussing a fascinating paper on what drinks ⬆or⬇ your risk of kidney stones on the hashtag #urojc http://t.co/…

StorkBrian
@aweizer1 @montrose52 @hollenbeck1971 @UMichUrology Discussing Kidney Stones this Month at #urojc Welcome your input! @DrHWoo @iurojc

nickbrookMD
@iurojc gr8 paper and potential practice changer…could dispel the any-fluid-is-good-fluid dogma #urojc

nickbrookMD
@MattBultitude good point, but we do base advice not to restrict Ca on evidence from same cohort, so NHS-II already changed practice #urojc

nickbrookMD
@denbysteele this month’s #urojc may be of interest to you…currently being discussed RE https://t.co/76lWnpNRZK

medsexual
RT @iurojc: Insightful #urojc RT“@hardy_bm@DrHWoo does the diuretic effect of the caffeine in energy drinks make up for the stone-forming…

JYLeeUroSMH
#urojc #kidneystones Intrsting paper. R findings applicable to most stone pts today? Cohort of health prof’s(⇑ SES), ⇓ meanBMI, ++white

nickbrookMD
RT @JYLeeUroSMH#urojc #kidneystones Intrsting paper. R findings applicable to most stone pts today? Cohort of health prof’s(⇑ SES), ⇓ meanBMI, ++white

JYLeeUroSMH
#urojc #kidneystones Incidence of stone events v. low? 582/51k (HPFS), 194/121k (NHS I) 858/116k (NHS II)

JYLeeUroSMH
#urojc #kidneystones Lastly, all known stone pts exclded. Do reslts apply to them? Does this change advice we give our recurrent stone pts?

JYLeeUroSMH
#urojc self-admittedly, we need better research/methodology in endourol (eg cf uro-onc) This subspclty issue discussd at AUA podium session

Tdave
@JYLeeUroSMH @UroOncologist @daviesbj @matthayn must include small batch arm #urojc

FlavorFaze
@iurojc where does Coke Zero fall into this equation? That’s my poison of choice. No renal colic episodes yet! #urojc

medskep
MT @LoebStacy#urojc Sound byte: Not all liquids are equal w/respect to #kidneystones. Avoid sugar soda/punch. Wine/coffee/tea good.

DrHWoo
T2 – twitter has been great for global journal club interaction such as #urojc. Succinct, targeted & great for time poor clinicians #hcsm

JYLeeUroSMH
MT @DrHWoo: twitter great for global journal club interaction (eg #urojc) Succinct, targeted, great for time poor clinicians #hcsm #hcsmca

DrRKSingal
Time to check in to #urojc. Sugary drinks and risk of #kidneystones #cdnhealth #onhealth http://t.co/Iij8P3fMk8

roccorossiTO
RT @DrRKSingal: Time to check in to #urojc. Sugary drinks and risk of #kidneystones #cdnhealth #onhealth http://t.co/Iij8P3fMk8

DrRKSingal
#urojc Not sure the cohort is very useful. Older population.Sedentary. Health care workers. Problem with not including recurrent formers.

DrRKSingal
And here’s a question for 2013. What about sugary coffees? a la @TimHortons @Starbucks etc #frappacinno #urojc

CBayneMD
#urojc enjoyed the paper and the ideas. Appreciate the effort the authors made to control for variables, track diet, and separate beverages

CBayneMD
#urojc unfort, paper highlights the inherent difficulty in assessing urolithiasis risk: dietary habits virtually impossible to truly control

CBayneMD
#urojc unless you can administer diet and control metabolic differences w/ 24hr urine, hard to draw anything by very soft correlations

Tdave
@CBayneMD You hit nail I’m the head! Association is NOT causality #urojc

CBayneMD
#urojc most interesting to me was signif p correlation with sugar-sweetened sodas but no signif in BMI, DM, and high BP

DrRKSingal
I am unclear re definition of stone incident. All Colic? Not sure of routine use of US in 1970s/80s.How 2account 4 asymptomatic stone #urojc

DrRKSingal
Well said MT @CBayneMD#urojc unless you can administer diet & control metabolic differences w/ 24hr urine, can only very soft correlations

FlavorFaze
@Tdave @CBayneMD isn’t this a disease of associations? Think it still helps direct pts on how to make real life intake decisions #urojc

CBayneMD
#urojc still about body’s default: the health(ier) diet (except spinach!) with lots of H2O is likely to lean toward less stone formation

DrRKSingal
& mind the salt MT @CBayneMD#urojc still about body’s default: healthier diet (except spinach!) with lots of H2O likely less stone formed

hardy_bm
#urojc @CBayneMD or even just the prevailing bias. Many super-powerful studies suffer from this. Ioannidis’ essay: http://t.co/tgNykrc05n

nickbrookMD
@DrRKSingal good point. we have this filth in Aus..branded ice coffee 58g sugar/600ml in packets http://t.co/nJQKjumNn1 #urojc

UroOncologist
So are the stone docs going to tell patients to drink tea? Was a longstanding tenant to avoid #urojc #questionvalidity @Tdave

DrRKSingal
I think the tea link is weak #urojc #oxalate @UroOncologist @Tdave

DrRKSingal
Us stone docs are firing up the Holmium Laser RT @UroOncologist: So are the stone docs going to tell patients to drink tea? #urojc @Tdave

DrRKSingal
@specialkdmd check in on #urojc over the next 48 hours. It is going on now #meded

Tdave
@UroOncologist perhaps…no. Moderation is key. But we’ve been basing on oxalate not caffeine, volume or whatever else T drinkers do #urojc

ClairWhelan
#urojc water, tea and coffee not magic, just cheap. And my grandpa always recommended adding scotch to negate the fish-poo

iurojc
RT @ClairWhelan#urojc water, tea and coffee not magic, just cheap. And my grandpa always recommended adding scotch to negate the fish-poo

doctorfullerton
RT @DrRKSingal: Time to check in to #urojc. Sugary drinks and risk of #kidneystones #cdnhealth #onhealth http://t.co/Iij8P3fMk8

LoebStacy
@CBayneMD #Diet studies hard in humans. Same in #prostatecancer -weak evidence for lycopene, #soy,green tea,etc but many confounders #urojc

FlavorFaze
@iurojc who over 12 yo drinks punch? Second, has anyone heard of “Big Red”. Popular in southern USA apparently. #cokezeroFTW #urojc

FerraroManuel
#urojc Greetings everybody, I’m the first author of the cJASN paper you are discussing. Happy you find it interesting

iurojc
RT @FerraroManuel#urojc Greetings everybody, I’m the first author of the cJASN paper you are discussing. Happy you find it interesting

FerraroManuel
#urojc @MattBultitude The study doesn’t show that non-colas are “better” than colas since the referent category for colas wasn’t non-colas

iThangasamy
@DrRKSingal @_TheUrologist_ @MattBultitude Can vouch that junior docs dehydrated often! QLD health talking about mandatory mealtime.. #urojc

iThangasamy
RT @JYLeeUroSMH#urojc #kidneystones Lastly, all known stone pts exclded. Do reslts apply to them? Does this change advice we give our rec…

iThangasamy
@DrRKSingal Agreed it is a very select group. Not sure if can apply to average Joe Blogs that walks on the door (John Doe if in US!) #urojc

iThangasamy
RT @DrRKSingal: Well said MT @CBayneMD#urojc unless you can administer diet & control metabolic differences w/ 24hr urine, can only very …

iThangasamy
RT @FerraroManuel#urojc Greetings everybody, I’m the first author of the cJASN paper you are discussing. Happy you find it interesting

iurojc
@FerraroManuel Welcome Dr. If you track back, there are a number of questions for which we’d value your thoughts. #urojc

linton_kate
@iThangasamy I suspect surgeons get v dehydrated on theatre days #urojc #needteabetweencases

FerraroManuel
#urojc @CBayneMD Agreed. Anyway, unless you don’t follow those participants to collect data on incident stones, you would only have data…

FerraroManuel
#urojc @CBayneMD …on urine composition, which doesn’t necessarily translate into kidney stones.

UrologyMatch
RT @iurojc@FerraroManuel Welcome Dr. If you track back, there are a number of questions for which we’d value your thoughts. #urojc

UrologyMatch
RT @FerraroManuel#urojc @MattBultitude The study doesn’t show that non-colas are “better” than colas since the referent category for colas wasn’t non-colas

UrologyMatch
RT @LoebStacy#urojc Sound byte: Not all liquids are equal w/respect to #kidneystones. Avoid sugar soda/punch. Wine/coffee/tea good. @sosa

UrologyMatch
RT @Tdave: Soda, cola: bad. Coffee, beer & wine: good. I like this paper! #urojc

iurojc
#urojc MT“@FerraroManuel: Ext validity is interesting issue. As others pointed out, we analyzed selected popltn; however, the distrib of…”

iurojc
#urojc MT“@FerraroManuel: risk factors was not diff from gen pop. Furthermore, other assoc found in these cohorts have been replicated…”

iurojc
#urojc RT“@FerraroManuel@iurojc …in other populations.”

iurojc
Check out great feedback from lead author @FerraroManuel http://t.co/QcwJRn0zto #urojc

FerraroManuel
#urojc @CBayneMD Sorry, I don’t follow you on this. The p-values reported for BMI/DM/HBP refer to effect modification not to association.

luisreyva
RT @UrologyMatch: RT @Tdave: Soda, cola: bad. Coffee, beer & wine: good. I like this paper! #urojc

Tdave
@LoebStacy @CBayneMD #Onlyamatteroftime Somebody would relate to prostate cancer #urojc

drerickgrullon
RT @LoebStacy: New study shows 1 or more sugar-sweetened cola/day increases #kidney #stone risk by 23% #urojc Attn @MikeBloomberg @jwgale #…

nickbrookMD
@FerraroManuel nice work. These stone popn studies have potential to change managmt..NHSII already changed approach to Ca advice #urojc

DrHLN
@FerraroManuel May I ask what defines punch? I agree with @DrHWoo that generally thought of in Oz as alcoholic #urojc #urojc

DrHLN
@FerraroManuel May I ask what defines punch? I agree with @DrHWoo that generally thought of in Oz as alcoholic #urojc

FerraroManuel
#urojc @DrHLN In the QTN we asked about punch intake defining it as fruit drink w/ sugar excluding fruit juices, e.g. Hawaiian Punch.

MattBultitude
@FerraroManuel @DrHLN Usually punch is very alcoholic in the UK ! Must be a lot of Hawaiian punch drinkers in the US ! #urojc

DrRKSingal
Not to mention the existence of the phrase ‘punch drunk’ @DrHLN @FerraroManuel @DrHWoo #urojc

DrRKSingal
Dr Ferraro, TY for coming. Nice paper. What about my earlier ? about sugary coffees? @FerraroManuel @DrHLN #urojc #frappacino

FerraroManuel
#urojc @DrRKSingal You’re welcome. Based on the info from the QTN, we couldn’t separate the “effects” of components of coffee or of…

FerraroManuel
#urojc @DrRKSingal …different types of coffee on the risk of stones. The “effect” of caffeine might offset that of oxalate/sugar…

FerraroManuel
#urojc @DrRKSingal …in the beverage.

FerraroManuel
#urojc @DrRKSingal I’m referring to “effect” in quotes since we just observe associations, not causal effects.

iThangasamy
MT #urojc @FerraroManuel@iurojc This is certainly impt. We adjusted analysis for total fluid consumption, hence assoc b/w each type of…”

iThangasamy
RT #urojc “@FerraroManuel@iurojc …beverage and stones should be considered as for subjects who drink the same amount of fluids.”

Tdave
So where are all the uro-onc tweeps? Scared of some stone paper? Can’t handle it? #gauntletthrown #urojc

MattBultitude
@Tdave – strangely silent – like they don’t understand it – let’s call it stone cancer – would that help ? #ButICantUseMyRobotForThis #urojc

matthayn
@MattBultitude You can still use robo for stones, right @Tdave#urojc

DrRKSingal
Be careful guys the pure oncologists usual laugh at our wonky trial designs in #endourology #urojc @MattBultitude @Tdave

KeithKow
@DrRKSingal @MattBultitude @Tdave I lasered TWO stones today! One is even getting a metabolic work up! The other a partial nx….. #urojc

DrRKSingal
Maybe but some new coffee concoctions have ridiculous amount of sugar. MT @FerraroManuel#urojc . caffeine may offset calories/oxalate

JYLeeUroSMH
#urojc @nickbrookMD @FerraroManuel Agree, nice work. Huge cohorts w/ undoubtedly +data to sift through. Also thx for joining convo. +valuble

JYLeeUroSMH
#urojc @FerraroManuel Wonder signif of caffeine on “relative dehydrtn” MDs “dehydrtd” all day in OR, drink after work. Total intake N but…

MattBultitude
All this talk of stones and the King seems becalmed and far less angry #urojc @daviesbj #GoodForHisBloodPressure

Tdave
@matthayn @MattBultitude absolutely! [see CJU editorial coming next month] #shamelessplug #urojc

daviesbj
@MattBultitude #urojc I don’t mind stones at all. Just nothing high volume. My ADD isn’t good for URS

peepeeDoctor
@MattBultitude@Tdave – #ButICantUseMyRobotForThis #urojc” but yes folks you can use the robot for complex stones. highly recommend

DrRKSingal
The plenary at #aua13 showed lap anatrophic for complete stag. waste of time @peepeeDoctor @MattBultitude @Tdave #urojc

DrRKSingal
for difficult ureteral stones can consider but very rare in my experi & pure lap okay & cheaper #urojc @peepeeDoctor @MattBultitude @Tdave

peepeeDoctor
@DrRKSingal: lap anatrophic for stag. waste of time” @MattBultitude @Tdave #urojc completely agree. Not so if robotic + cold ischemia.

Tdave
@DrRKSingal @MattBultitude Wonky? 194,095 pts ain’t too shabby #urojc

DrRKSingal
Agreed. Not this paper. #s are impressive. In general I meant and compared with large onc trials @Tdave @MattBultitude #urojc

sueurology
Can someone please tell me the makeup of “punch”. Surely each batch varies unless this is a product available OTC in the us.#urojc

DrRKSingal
Forget #urojc. Time for #bruinspens13 @KeithKow @daviesbj @matthayn @Tdave

Tdave
On hold RT @DrRKSingal: Forget #urojc. Time for #bruinspens13 @KeithKow @daviesbj @matthayn @Tdave

DrHWoo
See previous response by @ferraromanuel MT @sueurology Can someone pls tell me makeup of “punch”. #urojc

JYLeeUroSMH
@DrRKSingal @tdave @mattbultitude #urojc Agree impressive dataset. But generalizabilty limtd by focusd cohort. Also agree abt endo research

CBayneMD
@FerraroManuel I was surprised no significance was found with BMI or DM status. I think it lends support to significance of sugarcola #urojc

iThangasamy
RT @Tdave: So where are all the uro-onc tweeps? Scared of some stone paper? Can’t handle it? #gauntletthrown #urojc

sueurology
Sounds like I’ll have punch with a shot of caffeine. Preferably artificially sweetened. And a large shot of gin #urojc

DrHWoo
With regard to ‘sugar’ the paper suggests that we should perhaps differentiate between fructose and glucose. Thoughts @ferraromanuel#urojc

cooperberg_ucsf
Bet #urojc members knew this already: drink coffee, wine, beer! Skip (Diet) Coke. Didn’t need 2.6M person-years f/u… #BacktoCancer @iurojc

cooperberg_ucsf
In the meantime, HPFS has been _heavily_ analyzed; multiple comparisons problem applies. Also, control for comorbidity was inadequate #urojc

JustUro
@FerraroManuel @DrRKSingal Presume components=caffine+milk(if present)+water+sugar(if present). Decaf+tea similarly variable then? #urojc

JustUro
Using tab1’s data, overall median fluid intake for all grps <1.3L/d! Time for more coffee and wine… #urojc

UrologyMatch
RT @cooperberg_ucsf: Bet #urojc members knew this already: drink coffee, wine, beer! Skip (Diet) Coke. Didn’t need 2.6M person-years f/u… #BacktoCancer@iurojc

iurojc
Still another 10 hours to run for the June #urojc Still time to get your comments in.

iurojc
RT @JustUro: Using tab1’s data, overall median fluid intake for all grps <1.3L/d! Time for more coffee and wine… #urojc

Tdave
RT @iurojc: Still another 10 hours to run for the June #urojc Still time to get your comments in.

DrHLN
How sugary is your coffee?! Fructose in 1 tspn sucrose approx 2g vs 22g in cola, total sugar 4 vs 39g @DrRKSingal @FerraroManuel #urojc

DrHLN
Fructose the bad guy? No control for common foods high in fructose eg honey, fruits, processed foods/sauces/cereals #urojc

DrRKSingal
@DrHLN @FerraroManuel No sugar in mine but talking about stuff like this #urojc http://t.co/hx3rZqh5Om

Tdave
@DrRKSingal @DrHLN @FerraroManuel You all are making me hungry! #JustSayNoToFructose #urojc

DrHLN
Cola & apple juice both high sources fructose yet increased cola = stones despite caffeine diuresis vs no sig diff with increased AJ #urojc

DrRKSingal
Probably MT @JustUro@FerraroManuel Presume components=caffine+milk(if present)+H2O+sugar(if present). Decaf+tea similarly variable? #urojc

DrRKSingal
Or just more fluids. RT @JustUro: Using tab1’s data, overall median fluid intake for all grps <1.3L/d! Time for more coffee and wine. #urojc

DrHLN
Ok wow…and made with fructose syrup so high vs glucose! NOT making me hungry! @DrRKSingal @FerraroManuel @Tdave #urojc

DrAdamMurphy
RT @iurojc: Lets not forget the #urojc MT“@DrAdamMurphy@DrHWoo @LoebStacy ……..It has been postulated to be the diuretic action”

sosa_ernie
@LoebStacy I council patients to drink water avoiding sugar. For one there is a calciuric effect to sugar. #urojc who needs more cals?

DrRKSingal
Nice MT @sosa_ernie@LoebStacy I council: drink water avoiding sugar. For one there’s calciuric effect to sugar #urojc who needs more cals?

MattBultitude
2 hours left for #urojc this month. What top tips do people have as dietary advice for stone patients? Who uses lemons? Baking soda? Etc

LoebStacy
@MattBultitude #urojc good #kidneystone recs: more water, low added salt & animal #protein. Don’t restrict #calcium based on Borghi RCT.

PoppyPocket
RT @DrRKSingal: Nice MT @sosa_ernie@LoebStacy I council: drink water avoiding sugar. For one there’s calciuric effect to sugar #urojc who needs more cals?

DrRKSingal
That’s what I say + stay active. MT @LoebStacy@MattBultitude #urojc for #kidneystones more H20, <salt, animal #protein#calcium ok

declangmurphy
@MattBultitude Everything in moderation. And check your PSA. Or your husband’s PSA. This has been a LONG 48h #urojc#cancerplease

iurojc
June #urojc wraps up in about an hour? Great effort for our first ever non-oncology paper. Love to hear from our many observers/watchers

MattBultitude
@declangmurphy – oh come on Mr Murphy. I know you have loved stone cancer ever since you sucked a stent out with an elick evacuator! #urojc

iurojc
Big thks again author @FerraroManuel. Thanks also CJASN 4 allowing open access of article. Thanks @EUplatinum 4 Best Tweet prize #urojc

linton_kate
@iurojc what is next month? Female/recon? #urojc

iurojc
@linton_kate We are open to suggestions. Hot off press articles esp favored. We may have to do cancer in July to quell restlessness #urojc

iurojc
RT @sosa_ernie@LoebStacy I council patients to drink water avoiding sugar. For one there is a calciuric effect to sugar. #urojc who needs…

JYLeeUroSMH
@MattBultitude #urojc Depends on stone type but on balance, ⇑fluids (2L/d), ⇓salt, ⇑citrate (lemon or OJ). Ca & oxalate-rich ok in moderatn.

cooperberg_ucsf
@JYLeeUroSMH @MattBultitude Yep. Agree. Now, what @declangmurphy said! #urojc @iurojc

 

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.

Transcript of March 2013 #urojc

#urojc transcript

Healthcare Social Media Transcript

From: Sun Mar 03 12:00:00 PST 2013
To: Tue Mar 05 16:00:00 PST 2013
iurojc
Let the March #urojc begin Discussion is on quality if life in patients with small renal masses being managed conservatively

iurojc
Reminder that #urojc paper for March is now available for free download at http://t.co/aeW9htbGpg Don’t forget hashtag #urojc on every tweet

DovePress
RT @iurojc: Let the March #urojc begin Discussion is on quality if life in patients with small renal masses being managed conservatively

iurojc
#urojc Have we underestimated the impact of illness uncertainty as we push to awards conservative management?

linton_kate
@iurojc #urojc makes a great case for more onc nurse specialists and more t needed for counselling. Wonder abt diff in biopsy vs no biopsy

iurojc
For quick review & reminder of topic, see attached abstract #urojc http://t.co/vhYoz7freJ

iurojc
RT @linton_kate@iurojc #urojc makes a great case for more onc nurse specialists and more t needed for counselling. Wonder abt diff in …

DovePress
RT @linton_kate@iurojc #urojc makes a great case for more onc nurse specialists and more t needed for counselling. Wonder abt diff in …

DovePress
RT @iurojc: For quick review & reminder of topic, see attached abstract #urojc http://t.co/vhYoz7freJ

StorkBrian
RT @iurojc: For quick review & reminder of topic, see attached abstract #urojc http://t.co/vhYoz7freJ

UrologyMatch
How Twitter has helped me become a better doctor http://t.co/WFZPHFRsjA via @imedicalapps #urojc

iurojc
#urojc RT“@UrologieTwente@iurojc probably interesting to evaluate for prostate cancer patiënts in an Active surveillance protocol”

iurojc
Parker: “Illness uncertainty predicted general QOL, cancer specific QOL, and intrusive thoughts and avoidance behaviors” #urojc

iurojc
#urojc MT“@UrologieTwente: Underest impact of illness uncertainty as push towards conservative management?” Where do I find the answer?

DrHWoo
Reminder to all participants to include the hashtag #urojc in all discussion tweets – in this way your tweets will be seen. Thanks #urojc

DrHWoo
#urojc Average age of patients with SRMs was 72 years. Can imagine illness uncertainty issues greater in younger patients.

daviesbj
#urojc nobody died of illness uncertainty #deepdaviesthoughts

daviesbj
#urojc not having minorities represented in this cohort is a major problem

DrHWoo
But poor QOL probably sucks & could go on for years RT @daviesbj#urojc nobody died of illness uncertainty #deepdaviesthoughts #urojc

daviesbj
#urojc isn’t this publication from Texas? Pretty sure they have a robust minority community. este ensayo es parcial

daviesbj
#urojc Me pregunto por qué los hispanos no participar en la encuesta? #deepdaviesthoughts

iurojc
Yes, MD Anderson MT“@daviesbj#urojc isn’t this publ from Texas? Pretty sure they have a robust minority community. este ensayo es parcial

StorkBrian
@iurojc @DrHWoo I am surprised that the number of patients undergoing renal biopsy was so low. #urojc

StorkBrian
@DrHWoo @iurojc Also, of those biopsied, I am surprised to find the rate of RCCa detection so low #urojc

NatriceR
RT @UrologyMatch: How Twitter has helped me become a better doctor http://t.co/WFZPHFRsjA via @imedicalapps #urojc

DovePress
RT @StorkBrian@iurojc @DrHWoo I am surprised that the number of patients undergoing renal biopsy was so low. #urojc

lasenorarivera
RT @UrologyMatch: How Twitter has helped me become a better doctor http://t.co/WFZPHFRsjA via @imedicalapps #urojc

linton_kate
@StorkBrian @iurojc #urojc may be because of co-morbidities, 88 underwent ww due to age/co-morbidities

nickbrook12
#urojc what of QOL in pnx or radical nx patients with concerns of recurrence or renal failure? Lack of comparison makes study very weak

StorkBrian
@iurojc @DrHWoo Also, a Big Thanks to our Sponsor! @DovePress #urojc

iurojc
RT @nickbrook12#urojc what of QOL in pnx or radical nx patients with concerns of recurrence or renal failure? Lack of comparison makes …

DrHWoo
@nickbrook12 Probably would be an interesting next step but this is first time detailed illness uncertainty/QOL studied with SRMs #urojc

DrHWoo
http://t.co/eDTeZAibXM MT @daviesbj#urojc Me pregunto por qué los hispanos no participar en la encuesta? #urojc

StorkBrian
@DrHWoo @iurojc Curious to what degree you think a negative renal biopsy on a small renal mass would impact illness uncertainty. #urojc

DrHWoo
@StorkBrian Negative biopsy doesn’t absolutely rule out RCC. Are those more likely to get biopsies self selecting – more anxious? #urojc

sivanrij
#urojc interesting no deaths and no one came off WW at 2 years. Is part of the Clinical significance of unknowingness changing to active tx?

nickbrook12
@DrHWoo agree absolutely. But can’t conclude too much from this study because of its design #urojc

StorkBrian
@DrHWoo @iurojc That same question may apply to our prostate cancer patients as well #urojc

matthayn
What about cancer outcomes? Can we assume everybody did great? #urojc

UrologieTwente
@nickbrook12 study points out an interesting issue that has’nt been well described for urologic cancers and Active Surveillance #urojc

DovePress
RT @nickbrook12#urojc what of QOL in pnx or radical nx patients with concerns of recurrence or renal failure? Lack of comparison makes …

DovePress
RT @StorkBrian@iurojc @DrHWoo Also, a Big Thanks to our Sponsor! @DovePress #urojc

matthayn
Of course patients were uncertain. But did that influence any intervention? What was the reason for biopsy? #urojc

StorkBrian
@matthayn @DrHWoo @urojc Agree, I think this is a very good question. Patient anxiety, physician anxiety, or protocol? #urojc

StorkBrian
@iurojc A great topic of study would be how much anxiety does following a small renal cause the urologist? #urojc

_TheUrologist_
@StorkBrian @DrHWoo @iurojc a negative SRM Bx should not reassure – 80% or repeat biopsy shows RCC http://t.co/H9LbGCvyfl #urojc

daviesbj
#urojc Estoy harto de estudios centrados en blanco ancianos. vivimos en una sociedad multicultural

nickbrook12
@UrologieTwente agree. Just hope that QOL concern from 1 study doesn’t steer some urols from AS which is powerful tool for right pt #urojc

UrologieTwente
@nickbrook12 can not agree more for prostate cancer. Little less for smal RCC’s (because of kidney sparing techniques) #urojc

nickbrook12
@UrologieTwente fair point. But pn still major intervention with 20% grade 3/4 complication rate #urojc #gu13

urorao
#urojc QoL is an issue when there is life! Recent study shows AS better than Surgery! http://t.co/rj34rGW6Iy

DrRKSingaltegh
just checking in to #urojc

DrRKSingaltegh
@StorkBrian @iurojc @DrHWoo I suspect from 2006 to now you would probably see more biopsies. Certainly true with me #urojc

captfun99
#urojc @uretericbud how about competing risks in a 72 year old with a srm? Not much uncertainty if small. almost @lifeexpectancy!

DrRKSingaltegh
@StorkBrian @matthayn @DrHWoo @urojc And how well things were communicated. #urojc

urorao
#urojc Similar uncertainties ver first reported in AS for Ca Prostate! http://t.co/YfkwtxH99u

DrRKSingaltegh
certainly 4 elderly MT @urorao#urojc QoL is an issue when there is life! Recent study shows AS better than Sx! http://t.co/ugBcoeyYp6

StorkBrian
@_TheUrologist_ @drhwoo Points well taken Data from Ann Arbor that may + 2 or distract from the discussion http://t.co/ymb85MmJEL #urojc

urorao
#urojc Mark Litwin, father of QoL has shown that QoL in AS for prostate cancer still remains after 5years! http://t.co/cVHnGRJwiZ

DovePress
RT @StorkBrian@iurojc A great topic of study would be how much anxiety does following a small renal cause the urologist? #urojc

DrRKSingaltegh
@linton_kate @iurojc Agree, More of multidisciplinary approach leads to better communication. #urojc

nickbrook12
#urojc any ideas how we fund “targeted psychological interventions” for SRM pts in the Aus public health system?

OncLive
RT @DrRKSingaltegh: certainly 4 elderly MT @urorao#urojc QoL is an issue when there is life! Recent study shows AS better than Sx! ht …

StorkBrian
@_TheUrologist_ @drhwoo @iurojc This one as well out of the Department of Urology http://t.co/T4kG1h2KTp #urojc

urorao
#urojc Limitations – there was no structured or std’ized counseling/advice plan for discussing management approaches. Take Home Msg-Counsel!

DrRKSingaltegh
Excellent point MT @_TheUrologist_@StorkBrian @DrHWoo even with negative SRM Bx -80% on repeat Bx- RCC http://t.co/0tStfk4Cl9 #urojc

DrRKSingaltegh
@_TheUrologist_ @StorkBrian @DrHWoo @iurojc Bx especially of value when positive #urojc

UrologieTwente
@nickbrook12 true, complication rate is probably lower in expert centra and with cryo / rfa ablation, good options for small leasions #urojc

urorao
#urojc If considering bx, multiple areas to be sampled. Preop bx-limited ability to identify non-clear-cell histology http://t.co/bYwSSyZ3DJ

DrRKSingaltegh
@UrologieTwente @nickbrook12 Dont get bogged down by who Rx. Certainly AS fine 4 some.Cant imagine this will drive Uros 2 change #urojc

DrRKSingaltegh
@UrologieTwente @nickbrook12 We need to communicate better and manage the anxiety #urojc

DrRKSingaltegh
Is anyone else struck by fact that our 2 big GU cancers now part of AS debates? We really did overtreat for a long time #urojc

nickbrook12
@DrRKSingaltegh @UrologieTwente nail on the head! “targetted intervention” is a reassuring subspecialist engaging patient #urojc

StorkBrian
@DrRKSingaltegh FYI PEI is on my Bucket List! #urojc

DovePress
RT @nickbrook12#urojc any ideas how we fund “targeted psychological interventions” for SRM pts in the Aus public health system?

uretericbud
@captfun99 goal is to be able to quantitate risk. we r not quite there: http://t.co/1MngW85eGo http://t.co/UyCd1hI0Xo #urojc

uretericbud
@DrRKSingaltegh have to be extremely careful c these data. “no treatment” SEER group not same as true AS group in clinical practice. #urojc

UrologyMatch
@urorao depends whom you ask http://t.co/ezIIQ6nc92 @_TheUrologist_ thoughts regarding experience from this group? #toogoodtobetrue?#urojc

uretericbud
@urorao depends whom you ask:http://t.co/zmWytLWrCU … @_TheUrologist_ thoughts re this group’s experience? #toogoodtobetrue#urojc

matthayn
Yes indeed. See RPCI experience @uretericbud @urorao @_theurologist_ http://t.co/CRrIdZQ09U #urojc

_TheUrologist_
@uretericbud @urorao 1/3 Toronto series (n=345; 67%CC, 26%pap 7%chr) Surg path on 74; 86% subtype concordance. #urojchttp://t.co/H9LbGCvyfl

_TheUrologist_
@uretericbud @urorao 2/3 grade blurrier; only 64% graded. 9.9% F3, 0 F4. Only 8/61 F3 in above series (tough 2 say “highly accurate”) #urojc

_TheUrologist_
@uretericbud @urorao 3/3 in Toronto series, as usual ~80% successful, ~80% malignant. Does that mean “NNBx”=6.25 to find one benign? #urojc

uretericbud
@_TheUrologist_ @urorao Dx of “benign” in frail / elderly = #gamechanger #urojc

_TheUrologist_
RT @uretericbud@_TheUrologist_ @urorao Dx of “benign” in frail / elderly = #gamechanger #urojc

DrRKSingaltegh
@uretericbud @_TheUrologist_ @urorao I agree. I think that is the real value of biopsy. “benign” helps build the case 4 AS in frail #urojc

_TheUrologist_
2. SRMs are often benign. ~20% if <4cm (50% if <1cm) #urojc http://t.co/5yl3EI7yJZ

DrRKSingaltegh
Not to forget though that point of this paper is QofL.1.Yes anxiety exists, 2.We need to communicate better 3.Rx who we should #urojc

_TheUrologist_
3. SRMs tend to grow slowly, ~0.25cm/yr. (But variation is large, and some will grow rapidly, so must watch) #urojc http://t.co/eW3LPY6dRz

DrRKSingaltegh
@matthayn @uretericbud @urorao @_theurologist_ These seem to be bigger masses #urojc

_TheUrologist_
4. SRMs are very unlikely to present with metastatic dz #urojc http://t.co/p446gED2Sy http://t.co/l8jdnJ0pW9

_TheUrologist_
5. Surveyed SRMs are not likely to progress to mets #urojc @uretericbud @Marc_Smaldone http://t.co/vWCwELP1Ke

uretericbud
@_TheUrologist_ @Marc_Smaldone Yup. Looks like rapid kinetics are ominous (but benigns can exhibit those as well). #urojc

DrRKSingaltegh
@_TheUrologist_ @uretericbud @Marc_Smaldone Excellent summary Mike. Thanks #urojc

_TheUrologist_
6. SRM biopsy is helpful. ~80% diagnostic, ~20% benign. NNBx~7 to find 1 benign (if pathologist happy with benign call) #urojc

_TheUrologist_
@uretericbud @Marc_Smaldone true, growth lines in CDN series parallel for benign v malignant #urojc

iurojc
RT @_TheUrologist_@uretericbud @Marc_Smaldone true, growth lines in CDN series parallel for benign v malignant #urojc

dytcmd
@DrRKSingaltegh @uretericbud @_theurologist_ @urorao I think no bx is right if AS due to age/illness. If bx +, AS hard for pt 2 cont #urojc

_TheUrologist_
7. Lastly, elderly or infirm patients are likely to expire from other causes, with SRM in situ @uretericbud #urojc http://t.co/6oiqd7GNJV

_TheUrologist_
@dytcmd @DrRKSingaltegh @uretericbud @urorao agree – if no Tx planned, no sense in Bx #urojc

purdy_eve
This is a nice, brief review of SRM before the GU exam Thursday. Thanks #urojc. Have fun up there @_TheUrologist_

dytcmd
@_TheUrologist_ @drrksingaltegh @uretericbud @urorao Esp since majority of bx still expected to be + for RCC #urojc

dytcmd
@DrRKSingaltegh I’m curious how these scores compare to matched pts of comorbidity and no renal mass–there is no control grp #urojc

_TheUrologist_
@dytcmd @DrRKSingaltegh @uretericbud @urorao some say IDing high grade is Bx rationale; I think Bx best if motivated to find benign #urojc

dytcmd
@_TheUrologist_ @drrksingaltegh @uretericbud @urorao But grading poor on most bx series. And if pt too sick to rx, does grade matter? #urojc

_TheUrologist_
8. Despite all this, small RCC is still cancer, and lethal when horse leaves the barn. #urojc

DrRKSingaltegh
@dytcmd Agreed. Paper suggests simply that worry/anxiety exist #urojc

DrRKSingaltegh
Novel #meded in progress! MT @purdy_eve: This is a nice, brief review of SRM before the GU exam Thursday. Thanks #urojc@_TheUrologist_

iurojc
RT @_TheUrologist_@dytcmd @DrRKSingaltegh @uretericbud @urorao agree – if no Tx planned, no sense in Bx #urojc

DrHWoo
@DrRKSingaltegh @dytcmd Short of excising or ablating every SRM, do we have resources/expertise to manage the patient worry/anxiety #urojc

dytcmd
@DrHWoo @DrRKSingaltegh And we should have high bar to rec AS. Indication in the paper vague–most NOT for risk of CRI (ave eGFR >60)#urojc

DovePress
RT @DrRKSingaltegh@dytcmd Agreed. Paper suggests simply that worry/anxiety exist #urojc

DovePress
RT @uretericbud@_TheUrologist_ @urorao Dx of “benign” in frail / elderly = #gamechanger #urojc

johnleppert
@uretericbud @dytcmd @_theurologist_ @drrksingaltegh @urorao better estimates for pt life expectancy also integral to decision #urojc

DrRKSingaltegh
@dytcmd @DrHWoo our counsel frames everything. #urojc

iurojc
Can we justify moving this work on to a multicenter study with a control or comparative limb? RCT impossible/impractical? #urojc

iurojc
Are we just simply contributing to a growing population of worried well? #urojc

iurojc
RT @DrRKSingaltegh@dytcmd @DrHWoo our counsel frames everything. #urojc

iurojc
Take part in the March #urojc to win a free manuscript from @DovePress : http://t.co/h1bKK5g2T0

nickbrook12
@iurojc this popn is already there; others do the imaging, urols job is to steer correct management for incid SRM #urojc

DrHWoo
@penorthesword A tweet to the death is it? 🙂 #urojc

IsaacThangasamy
RT @iurojc: For quick review & reminder of topic, see attached abstract #urojc http://t.co/vhYoz7freJ

IsaacThangasamy
RT @StorkBrian@iurojc A great topic of study would be how much anxiety does following a small renal cause the urologist? #urojc

IsaacThangasamy
RT @DrRKSingaltegh@dytcmd @DrHWoo our counsel frames everything. #urojc

IsaacThangasamy
RT @iurojc: Take part in the March #urojc to win a free manuscript from @DovePress : http://t.co/h1bKK5g2T0

dytcmd
.@DrRKSingaltegh @drhwoo Agreed. The unmeasured variable of paper is what were patients told, and was it consistent btw docs. #urojc

_TheUrologist_
.@rhankb short answer no. UHN 1 case of benign->chromophobe. Key is not to interpret non-Dx as benign, as 80% RCC on repeat Bx #urojc

_TheUrologist_
@rhankb biopsy if known benign would avoid surgery. Not for all SRM for sure #urojc

rhankb
@_TheUrologist_ An incorrectly benign biopsy has potential implications on surveillance compliance. Why not forgo biopsy and follow #urojc

_TheUrologist_
Any uro-paths to weigh in on oncocytoma vs chromophobe on core Bx? Report usually “oncocytic mass, consistent w/ _X_” #urojc

DrRKSingaltegh
@dytcmd @IsaacThangasamy @uretericbud @_theurologist_ @urorao Well said Dave. Patients make best informed decisions on our lead #urojc

NeomedicInt
Needleless sling for Female SUI treatment: Single Incision (minimally invasive) TOT. http://t.co/IPO7gPDcfq #TOT #TVT #Minisling #urojc

iurojc
Calling on pathologists! MT “@_TheUrologist_: Any uro-paths to weigh in on oncocytoma vs chromophobe on core Bx? #urojc

iurojc
#urojc MT“@benchallacombe: The 17 who had a biopsy should be looked at separately. impact of a clinical psychologist on this?”

iurojc
@Williamson_SR @uropathology Are you able to help with our query? Follow #urojc discussion that is on right now

UrologieTwente
@daviesbj @upmcnews #urojc It is said round here “don’t make an elephant out of a mouse” what is right for one is wrong for another #rtx

njtouma
Must control for counselling session when looking at anxiety in AS pts. #urojc

Williamson_SR
@iurojc @_TheUrologist_ #urojc Controversial btw uropaths, our group is willing to call onco but this week at USCAP mtg some argue against

njtouma
How clinicians present Dx and implications likely big factor in provoking anxiety. #artofmedicine #urojc

njtouma
Trial itself is anxiety inducer: close & repeated calls by research team makes one think disease is life threatening! #urojc

iurojc
Int perspective MT @njtouma: Trial is anxiety inducer: close & repeated calls by research tm makes think disease is life threatening! #urojc

DovePress
RT @iurojc: Take part in the March #urojc to win a free manuscript from @DovePress : http://t.co/h1bKK5g2T0

DrHWoo
@benchallacombe 17/27 of biopsied had RCC. Interesting to look at those +ve or -ve biopsy results although numbers might be small #urojc

iurojc
What about percutaneous ablative techniques? Could they give some reassurance that something being done but not over top? Thoughts? #urojc

benchallacombe
@DrHWoo #urojc yes it may be to do with the uncertainty rather than living with “cancer” Counselling is key.

DrRKSingaltegh
@benchallacombe @DrHWoo Counselling and communication is absolutely the key and to my mind the only significant point of the paper #urojc

DrRKSingaltegh
@iurojc Doing ablative Rx simply 2 provide reassurance amounts 2 sham therapy. Treat appropriately & for AS, communicate effectively #urojc

DrRKSingaltegh
@IsaacThangasamy If only our #pancreaticcancer colleagues could have an AS discussion! GU cancers variable and unique #urojc

njtouma
Committing to ablation = committing to Rx; what’s the next step if ablation fails? Return to AS! #urojc

DrMarniqueB
QOL assessmt v useful in screening for high risks pts. Practically i suspect difficult to use to target psychosocial interventions #urojc

njtouma
Metaanalysis: Complications from ablative techniques up to 20% #notbenign #urojc http://t.co/x9abqS3EMg

daviesbj
@DrRKSingaltegh @isaacthangasamy #urojc I doubt our cancers are unique. See squam skin cancer, colon adenomas, cervical dysplasia, etc.

DrHWoo
@njtouma Post ablation, monitoring protocol similar to AS. Poss diff illness anxiety/QOL with Rx follow up vs potentially unRx tiger? #urojc

DrHWoo
@njtouma Devil in detail – MA of case series – pioneering/learning curve, some several years old, some old technology etc. #urojc

njtouma
.@DrHWoo agree that it may calm nerves! However, Other than ECT, this becomes only surgery with anxiety as indication! #urojc

_TheUrologist_
@njtouma @DrHWoo don’t forget HIFU for CaPr on that list of anxiolytic Tx. Whatta town! #urojc

dytcmd
@johnleppert @uretericbud @_theurologist_ @drrksingaltegh @urorao I think still too many variables and prediction will remain rough. #urojc

_TheUrologist_
@dytcmd @johnleppert @uretericbud @DrRKSingaltegh @urorao why don’t we just hire insurance underwriters to tell us? 😉 #urojc

iurojc
#urojc RT @KeithKow: Save the nephrons!! “Comparative effectiveness, costs and trends in treatment of SRMs” http://t.co/CH0nNjKZcR @qdtrinh

dytcmd
@_TheUrologist_ @johnleppert @uretericbud @drrksingaltegh @urorao That’s what I use: US Social Security life estimate tables! #urojc

DrRKSingaltegh
@dytcmd @_TheUrologist_ @johnleppert @uretericbud @urorao #urojc seems very reasonable to me

matthayn
@DrRKSingaltegh @dytcmd @_TheUrologist_ @johnleppert @uretericbud @urorao But need to adjust SS tables based on health status #urojc

lawrentschuk
#urojc paper proves cancer surveillance is all about pre-biopsy counseling. Tumour like polyp safer word, more buy in. We must lead on this!

IsaacThangasamy
@dytcmd @uretericbud @_theurologist_ @drrksingaltegh @urorao #urojc MT Surgeon’s counsel impt for bx or no bx, and what is the endgame?

IsaacThangasamy
@daviesbj @drrksingaltegh #urojc Ask the patients if cancer is unique. Philosophical… But I get what you’re saying.

DrRKSingaltegh
@daviesbj @isaacthangasamy If we are now counting some #GUcancers with this group it further highlights how much we overtreated B4 #urojc

iurojc
RT @lawrentschuk#urojc paper proves cancer surveillance is all about pre-biopsy counseling. Tumour like polyp safer word, more buy in. …

daviesbj
@lawrentschuk #urojc you spell tumor funny

DrRKSingaltegh
@wandering_gu @dytcmd @_TheUrologist_ @uretericbud @urorao Agreed. I shared this a few days ago as well. Nice algorithm #urojc

wandering_gu
@DrRKSingaltegh @benchallacombe @DrHWoo As with prostate biopsy, AS/WW counseling needs to begin before SRM biopsy–setup is the key.#urojc

wandering_gu
RT @lawrentschuk#urojc paper proves cancer surveillance is all about pre-biopsy counseling. Tumour like polyp safer word, more buy in. …

DrHWoo
@daviesbj It is not a tumor! #urojc

dytcmd
@IsaacThangasamy @uretericbud @_theurologist_ @drrksingaltegh @urorao It not impt for bx/no bx but for rx or AS. To bx just 1 part. #urojc

johnleppert
@dytcmd @_theurologist_ @uretericbud @drrksingaltegh @urorao try http://t.co/Tum44Ayk6z and Jama review http://t.co/R3DCZuRDlp #urojc

urorao
#urojc Take home msg: urologists good at counselling AS in CaP but poor at counselling AS in renal lesions! #urologybeyondprostate

iurojc
RT @urorao#urojc Take home msg: urologists good at counselling AS in CaP but poor at counselling AS in renal lesions! #urologybeyondp …

iurojc
Any other take home messages as you see it from this study? #urojc http://t.co/3WUJMWp7Oy

iurojc
This exc paper on SRM Rx by @keithkow @qdtrinh is hot off press on @BJUIjournal http://t.co/CH0nNjKZcR & highly relevant to this #urojc

iurojc
This piece on SRMs published in @NatRevUrol on line today is also highly relevant to this #urojc – SRM discussion is flavour of the month

UrologieTwente
@urorao there is no prostate sparing operation for Pca unfortunaty 😉 We love nefronsparing! #ZGT #urojc

DrHWoo
@BladderCancerUK Often the concern is “when will the cancer progress” and “will I miss the boat”. We need to counsel better #urojc

_TheUrologist_
@iurojc pts who will be miserable & terrified will not thrive on SRM surveillance. Should factor in Tx decision if all options open #urojc

iurojc
About 15 minutes to go for any final final comments in the March #urojc paper! http://t.co/nooU21fFFu

urorao
#urojc Dbate on QoL in Mx SRM has just began. Wil see a series of papers in the near future. b ready 2 discus a few more in months 2 come!

 

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

 

 

Transcript of January 2013 #urojc

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

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

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

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

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

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

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

matthayn
No phi up in Maine #urojc #moremoosethanpeople

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

DrRKSingaltegh
@iurojc #urojc Not us here in Cda.

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

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

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

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

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

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

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

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

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

iurojc
@LoebStacy Does FDA approval cover Canada? #urojc

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

dmsomford
RT @iurojc: Looking forward to the thoughts of our European colleagues to the excellent discussion on #urojc<