Archive for year: 2015

Video: Holmium Laser Enucleation and Photoselective Vaporization of the Prostate for Patients with Benign Prostatic Hyperplasia and Chronic Urinary

Holmium Laser Enucleation and Photoselective Vaporization of the Prostate for Patients with Benign Prostatic Hyperplasia and Chronic Urinary Retention

Christopher D. Jaeger, Christopher R. Mitchell, Lance A. Mynderse and Amy E. Krambeck

Department of Urology, Mayo Clinic School of Medicine, Rochester, MN, USA

OBJECTIVES

To evaluate short-term outcomes of holmium laser enucleation of the prostate (HoLEP) and photoselective vaporisation of the prostate (PVP) in patients with benign prostatic hyperplasia (BPH) and chronic urinary retention (CUR).

PATIENTS AND METHODS

A retrospective chart review was performed of all patients with CUR who underwent HoLEP or PVP at our institution over a 3-year period. CUR was defined as a persistent post-void residual urine volume (PVR) of >300 mL or refractory urinary retention requiring catheterisation.

RESULTS

We identified 72 patients with CUR who underwent HoLEP and 31 who underwent PVP. Preoperative parameters including median catheterisation duration (3 vs 5 months, P = 0.71), American Urological Association Symptom Index score (AUASI; 18 vs 21, P = 0.24), and PVR (555 vs 473 mL, P = 0.096) were similar between the HoLEP and PVP groups. The HoLEP group had a larger prostate volume (88.5 vs 49 mL, P < 0.001) and higher PSA concentration (4.5 vs 2.4 ng/mL, P = 0.001). At median 6-month follow-up, 71 (99%) HoLEP patients and 23 (74%) PVP patients were catheter-free (P < 0.001). Of the voiding patients, postoperative AUASI (3 vs 4, P = 0.06), maximum urinary flow rate (23 vs 18 mL/s, P = 0.28) and PVR (56.5 vs 54 mL, P = 1.0) were improved in both groups.

CONCLUSIONS

Both HoLEP and PVP are effective at improving urinary parameters in men with CUR. Despite larger prostate volumes, HoLEP had a 99% successful deobstruction rate, thus rendering patients catheter-free.

Kenny Rogers’ Law of Surgical Practice

james-duthieAlthough not a Country Music fanatic, I would like to acknowledge the contribution that Kenny Rogers, elder statesman of the genre, has made to the practice of modern surgery. I refer to his insightful song, and subsequent film, The Gambler. For the uninitiated, the song describes a chance meeting between a world-weary professional card player and an aspiring young gambler. If you are gambling lover then you may know Bitbola is a sbobet88 Mobile Indonesia site that provides a variety of online gambling games such as Sportsbook, Online Casino, Agile Ball, Online Poker, Online Togel, Cockfightingand many more, with a minimum deposit of only 25 thousand. There are so many benefits to be gained when you join Bitbola. For now, Bitbola is the Official SBOBET Mobile site in Indonesia which is well-known among all online gambling lovers. People are loving to play w88 games. The older man gifts the younger with pearls of wisdom on winning at cards, culminating in a chorus stating that a player needs to “know when to hold ‘em, know when to fold ‘em, know when to walk away, know when to run”. I am not for a minute condoning the practice of surgeons literally running away from their patients, however strong the urge, but I do think some of the other sentiments are instructional in our practice.

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Many gamblers enjoy going to a formal casino, but they are finding that a good casino on-line site can offer them just as much fun as the brick and mortar casinos, but all from the convenience of home. Both novice gamblers who are in the process of learning new games and mastering ones that they are somewhat familiar with, and the seasoned gamblers will find sites that offer challenging and high-roller tournaments that they will enjoy. These web-based casinos offer so many benefits that give players some great incentives to continue playing – and winning!

Available Games

When the players are looking at a casino on-line, they will find numerous Poker games, Blackjack, Baccarat, Keno, Pai Gow, and a variety of games that all levels of players can enjoy. Also take a look at the site to see the various types of slot games and video slot games that have great odds and offer a wide range of table and slot rates to play. The best sites allow players to play for fee while they are learning the games and there are no limitations to how long they can play for fee before they are required to deposit money.

Bonuses and Incentives

In general, players will try out a number of on-line casinos before finding one that they feel the most comfortable depositing money and one that they are offered the best incentives and bonuses. Many sites offer matching bonuses and a variety of incentives to continue playing at that site. Other sites have betting requirements before the players can withdraw the money they have won – be sure to read and understand the requirements for deposits and withdrawals before putting money into the site. Also, consider the minimum wagers for the sites (particularly good for beginners) and the maximum bets allowed that experienced gamblers will find more challenging. Look for sites that have monthly bonuses, loyalty incentives, and provide a variety of reasons (in addition to high-quality games and safety) to entice the gambler to return to their site.

The revelation came to me as a student, staying in the hospital late with the senior surgical trainee on call, hoping for something exciting to come through the door. Late that night, a very elderly, frail woman arrived shocked, in agony, confused, combative, and in multi-organ failure. The CT showed a significant portion of her small bowel was ischaemic. The trainee drilled me on management options; thrombolysis or endovascular techniques were impractical here, leaving only extensive resection; anastomosis with proximal diversion. Of course this would be a high-output stoma with associated high loss of fluid and electrolytes, difficult to manage, she would be a poor candidate for elective reversal… It did occur to me that this was going to be tough on the poor lady, and probably even futile, but a student can’t say “let’s just keep her comfortable” on a surgical rotation. The trainee had the experience and humility to suggest it himself. He confirmed my predictions of failed extubation, a prolonged ICU admission with worsening multi-organ failure, debates about whether to dialyse, increasing vasopressor and inotrope support, undying hope from the family that she would “turn the corner”, until finally a wrecked shell of a human being would succumb to an unavoidable complication of her treatment. “Sometimes, you’ve got to know when to call it quits”. This inspired me. “You’ve got to know when to hold ‘em, know when to fold ‘em?”. “Exactly”, he replied, and Kenny Rogers’ Law was born.

A mentor of mine once said, “there is no medical condition that can not be made worse with a poorly conceived operation”. This is the doctrine I cling to when feeling pressured to “push the envelope”, or attempt “heroic surgery” in the face of good sense. The most important factor influencing surgical outcomes is patient selection. Poor substrate results in poor results. The problem is that complex surgical problems often come wrapped in the most sympathetic, heart-breaking packaging. The delightful lady with a neurological disorder who is really fed up with the urinary diversion she had twenty years ago. The poor old fellow who can’t bear his nephrostomy. The tearful wife who asks if there is anything, ANYTHING you can do for him? At a departmental meeting it might be easy to assess these cases in a cold academic light, and rightly recommend against intervention. But then you don’t have to face the desperate human face of suffering at the meeting.

A surgeon I know who has a million useful platitudes once told me that if I was planning to do a surgery, but was not sure of the wisdom of it, to say out loud what I was going to do in the past tense with the preface, “well, Your Honour…” If you have never done this, I recommend it. “Well, Your Honour, I know she was morbidly obese and had had multiple laparotomies in the past with significant adhesion disease, and was admitted to the ICU with profound sepsis each time, but even though her dexterity is too poor for her to effectively self-catheterise, I thought it would be worth trying to reverse her ileal conduit and perform a clam cystoplasty. She was really sick of her conduit.”

As doctors, rather than just surgeons, sometimes our role is to convince a patient that however bad they think things are, we could certainly make things worse for them. Undoing an operation and its complications is usually not easy, and often impossible. Better to know when to fold ‘em.

 

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Live Surgery Poll Results

Live surgery as an approach for surgical learning, has recently been given approval by the EAU albeit with strict guidelines to optimise the benefits. However this potential teaching tool is in its infancy and the mechanism(s) to optimise learning have not yet been clearly defined.

 

Which statements do you most agree with:

1. Live surgery is an important tool to disseminate surgical expertise and should be considered in multiple settings, as long as the surgeon has suitable expertise – 40.54%

2. Live surgery is an important tool to disseminate surgical expertise but should be restricted to experienced surgeons operating from home institutions, with an experienced surgical team, familiar with the operation technique – 37.84%

3. Live surgery increases potential risks to the patient and is therefore never justified – 21.62%

 

 

Which statements do you most agree with:

1. Live surgery can be of benefit in multiple types of surgical learning and should be considered in endoscopic, laparoscopic and robotic surgery – 52.78%

2. Live surgery should primarily be considered for training in laparoscopic surgery – 13.89%

3. Live surgery should primarily be considered for training in robotic surgery – 19.44%

4. Live surgery increases potential risks to the patient and is therefore never justified – 13.89%

 

Article of the Week: Enzalutamide in European and North American men participating in the AFFIRM trial

Every week the Editor-in-Chief selects the Article of the Week from the current issue of BJUI. The abstract is reproduced below and you can click on the button to read the full article, which is freely available to all readers for at least 30 days from the time of this post.

In addition to the article itself, there is an accompanying editorial written by a prominent member of the urological community. This blog is intended to provoke comment and discussion and we invite you to use the comment tools at the bottom of each post to join the conversation.

Finally, the third post under the Article of the Week heading on the homepage will consist of additional material or media. This week we feature a video from Dr. Axel Merseburger discussing his paper. 

If you only have time to read one article this week, it should be this one.

Enzalutamide in European and North American men participating in the AFFIRM trial

Axel S. Merseburger, Howard I. Scher†, Joaquim Bellmunt‡, Kurt Miller§, Peter F.A. Mulders¶, Arnulf Stenzl**, Cora N. Sternberg††, Karim Fizazi‡‡, Mohammad Hirmand§§, Billy Franks¶¶, Gabriel P. Haas¶¶, Johann de Bono*** and Ronald de Wit†††

Medizinische Hochschule Hannover, Hannover, §Charité – Universitätsmedizin Berlin, Berlin, **Universitätsklinikum Tübingen, Tübingen, Germany; †Memorial Sloan-Kettering Cancer Center, New York, NY, ‡Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, §§Medivation, Inc., San Francisco, CA, ¶¶Astellas Scientific and Medical Affairs, Inc., Northbrook, IL, USA; ¶Radboud University Nijmegen Medical Centre, Nijmegen, †††Erasmus University Medical Center, Rotterdam, The Netherlands; ††San Camillo – Forlanini Hospitals, Rome, Italy; ‡‡Institut Gustave Roussy, University of Paris Sud, Villejuif, France; ***Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, UK

Read the full article

OBJECTIVE

To explore any differences in efficacy and safety outcomes between European (EU) (n = 684) and North American (NA) (n = 395) patients in the AFFIRM trial (NCT00974311).

PATIENTS AND METHODS

Phase III, double-blind, placebo-controlled, multinational AFFIRM trial in men with metastatic castration-resistant prostate cancer (mCRPC) after docetaxel. Participants were randomly assigned in a 2:1 ratio to receive oral enzalutamide 160 mg/day or placebo. The primary end point was overall survival (OS) in a post hoc analysis.

RESULTS

Enzalutamide significantly improved OS compared with placebo in both EU and NA patients. The median OS in EU patients was longer than NA patients in both treatment groups. However, the relative treatment effect, expressed as hazard ratio and 95% confidence interval, was similar in both regions: 0.64 (0.50, 0.82) for EU and 0.63 (0.47, 0.83) for NA. Significant improvements in other end points further confirmed the benefit of enzalutamide over placebo in patients from both regions. The tolerability profile of enzalutamide was comparable between EU and NA patients, with fatigue and nausea the most common adverse events. Four EU patients (4/461 enzalutamide-treated, 0.87%) and one NA patient (1/263 enzalutamide-treated, 0.38%) had seizures. The difference in median OS was related in part to the timing of development of mCRPC and baseline demographics on study entry.

CONCLUSION

This post hoc exploratory analysis of the AFFIRM trial showed a consistent OS benefit for enzalutamide in men with mCRPC who had previously progressed on docetaxel in both NA- and EU-treated patients, although the median OS was higher in EU relative to NA patients. Efficacy benefits were consistent across end points, with a comparable safety profile in both regions.

Editorial: Geography – an increasingly important variable in prostate cancer clinical trials

Enzalutamide is approved in the post-docetaxel phase for men with metastatic castrate-resistant prostate cancer (mCRPC) in North America (NA) and the European Union (EU). Merseburger et al. [1] now take a first look at comparing the efficacy and safety of enzalutamide in EU and NA patients treated in the AFFIRM trial. AFFIRM was a phase III double-blind, placebo-controlled multinational trial evaluating whether enzalutamide prolongs overall survival (OS) in men with mCRPC after docetaxel chemotherapy. This post hocexploratory analysis found a consistent OS benefit in both NA- and EU-treated patients. The safety profile was comparable in both regions.

Interestingly, the median OS appeared longer in the EU as compared with the NA cohort (‘not yet reached’ vs 17.4 months). With the placebo group in the EU the median survival was 16.2 vs 12.3 months in the NA cohort (3.9 months different). Direct statistical comparisons between regions were not performed but a median survival difference of 3.9 months is not inconsequential. Notably, drugs have been approved with lesser difference in OS.

The populations in AFFIRM have some baseline differences that may be of importance; the median time from diagnosis to randomisation was 68.9 months in the EU cohort vs 78.0 months in the NA cohort. Thus, it was possible that the NA cohort was ‘further along’ in the natural history of the disease despite apparently being well-balanced according to most baseline variables. The NA cohort was slightly more likely to have higher Gleason scores (50.6%) vs the EU cohort (44.0%), suggesting perhaps a slight difference in disease aggressiveness. It is also interesting that cardiac disease was present in 23.3% of the NA cohort vs only 7.2% of the EU cohort. Is it possible that cardiovascular diseases also contributed to a relative increase in mortality in the NA cohort? With regard to the post-protocol therapies, the use of abiraterone was more common in the EU cohort (30.5% of patients in the placebo group subsequently received abiraterone in the EU cohort vs 19.7% in the NA cohort). However, utilisation of cabazitaxel was more common in NA than in the EU (20.5% vs 9.9%). Some combination of pre-treatment and post-protocol variables in AFFIRM is probably the explanation for geographic variations in OS. Protocol treatments were well defined but these variables were not controlled.

These results in AFFIRM should also be considered in the context of geographic differences in medical care that may alter results and/or interpretation of phase III trials. Some of these differences have been previously documented in other phase III mCRPC trials. For instance, the recent phase III trials with orteronel reported no OS differences in the overall study [2]. However, in certain geographic regions (with less access to the newer life-prolonging drugs), the orteronel trials were clearly positive for the OS endpoint. In the TROPIC trial, cabazitaxel was associated with higher febrile neutropenia rates in some EU countries as compared with the USA. This was primarily due to geographic differences in prophylactic administration of granulocyte colony-stimulating factor (G-CSF) [3]. For the ALSYMPCA trial, striking geographic differences were noted in the timing (pre- or post-docetaxel) of radium-223 utilisation [4].

Understanding prognosis and treatment outcomes is increasingly critical in the design and interpretation of phase III clinical trials and particularly amongst trials that are designed to support regulatory approvals. Region or country where treatment takes place is an important variable to consider, especially if approved pre- and post-protocol treatments are not the same. This issue is even more important if the course of the disease is long (as in prostate cancer) and there are different treatments available from country to country.

Read the full article

Oliver Sartor, Sumanta Kumar Pal*, Terhi Hermanson† and Charles L. Bennett‡,

Tulane Medical School, New Orleans, LA, *City of Hope Comprehensive Cancer Center, Duarte, CA, USA; † Helsinki University Central University, Helsinki, Finland; and ‡ College of Pharmacy, Medical University of South Carolina Cancer Center, Charleston, SC, USA

References

1 Merseburger AS, Scher HI, Bellmunt J et al. Enzalutamide in European and North American men participating in the AFFIRM trial. BJU Int 2015; 115: 41–9

2 Fizazi K, Jones R, Oudard S et al. Regional differences observed in the phase 3 trial (ELM-PC 5) with orteronel (TAK-700) plus prednisone in patients with metastatic castration-resistant prostate cancer (mCRPC) that has progressed during or following docetaxel. ASCO Meeting Abstracts. J Clin Oncol 2014; 32 (Suppl.): 5s (abstr 5042). Available at: https://meetinglibrary.asco.org/content/126314-144. Accessed November 2014

3 Ozguroglu M, Oudard S, Sartor AO et al. Effect of G-CSF prophylaxis on the occurrence of neutropenia in men receiving cabazitaxel plus prednisone for the treatment of metastatic castration-resistant prostate cancer (mCRPC) in the TROPIC study. ASCO Meeting Abstracts. J Clin Oncol 2011; 29 (Suppl.): abstr 144. Available at: https://meetinglibrary .asco.org/content/72386-104. Accessed November 2014

4 Parker C, Nilsson S, Heinrich D et al. Alpha emitter radium-223 and survival in metastatic prostate cancer. N Engl J Med 2013; 369: 213–23

 

Video: Enzalutamide in European and North American men participating in the AFFIRM trial

Enzalutamide in European and North American men participating in the AFFIRM trial

Axel S. Merseburger, Howard I. Scher†, Joaquim Bellmunt‡, Kurt Miller§, Peter F.A. Mulders¶, Arnulf Stenzl**, Cora N. Sternberg††, Karim Fizazi‡‡, Mohammad Hirmand§§, Billy Franks¶¶, Gabriel P. Haas¶¶, Johann de Bono*** and Ronald de Wit†††

Medizinische Hochschule Hannover, Hannover, §Charité – Universitätsmedizin Berlin, Berlin, **Universitätsklinikum Tübingen, Tübingen, Germany; †Memorial Sloan-Kettering Cancer Center, New York, NY, ‡Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, §§Medivation, Inc., San Francisco, CA, ¶¶Astellas Scientific and Medical Affairs, Inc., Northbrook, IL, USA; ¶Radboud University Nijmegen Medical Centre, Nijmegen, †††Erasmus University Medical Center, Rotterdam, The Netherlands; ††San Camillo – Forlanini Hospitals, Rome, Italy; ‡‡Institut Gustave Roussy, University of Paris Sud, Villejuif, France; ***Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, UK

Read the full article

OBJECTIVE

To explore any differences in efficacy and safety outcomes between European (EU) (n = 684) and North American (NA) (n = 395) patients in the AFFIRM trial (NCT00974311).

PATIENTS AND METHODS

Phase III, double-blind, placebo-controlled, multinational AFFIRM trial in men with metastatic castration-resistant prostate cancer (mCRPC) after docetaxel. Participants were randomly assigned in a 2:1 ratio to receive oral enzalutamide 160 mg/day or placebo. The primary end point was overall survival (OS) in a post hoc analysis.

RESULTS

Enzalutamide significantly improved OS compared with placebo in both EU and NA patients. The median OS in EU patients was longer than NA patients in both treatment groups. However, the relative treatment effect, expressed as hazard ratio and 95% confidence interval, was similar in both regions: 0.64 (0.50, 0.82) for EU and 0.63 (0.47, 0.83) for NA. Significant improvements in other end points further confirmed the benefit of enzalutamide over placebo in patients from both regions. The tolerability profile of enzalutamide was comparable between EU and NA patients, with fatigue and nausea the most common adverse events. Four EU patients (4/461 enzalutamide-treated, 0.87%) and one NA patient (1/263 enzalutamide-treated, 0.38%) had seizures. The difference in median OS was related in part to the timing of development of mCRPC and baseline demographics on study entry.

CONCLUSION

This post hoc exploratory analysis of the AFFIRM trial showed a consistent OS benefit for enzalutamide in men with mCRPC who had previously progressed on docetaxel in both NA- and EU-treated patients, although the median OS was higher in EU relative to NA patients. Efficacy benefits were consistent across end points, with a comparable safety profile in both regions.

Into Africa: Engaging with urology in the developing world

A version of this blog has also been published on the Trends in Urology and Men’s Health site

We have just completed a superb RSM winter meeting on the East African ‘Spice Island’ of Zanzibar. In addition to exciting updates in urological practice within the UK, the president of Zanzibar attended the meeting to give a fascinating insight into the history, problems and challenges facing Zanzibar.

However it was our interaction with local healthcare professionals during our visits to the islands hospitals which made the focus of the meeting (urology in the developing world) especially poignant. Delegates had the opportunity to visit the Mnazi Mmoja Hospital in Stone Town, where workshops were held with local doctors, as well as more rural hospitals in Makunduchi and Kivunge. The delegates at the meeting were joined by colleagues from South Africa, mainland Tanzania, two English and one American urologist who have dedicated a significant proportion of their professional lives to healthcare in Africa.

Professor Joseph Smith from Tennessee has worked from Liberiato Malawi and the DRC to Ethiopia over the years. He has faced war, floods and now Ebola. His efforts to affect lasting change through training have been further challenged by the issue of retention of doctors, many of whom can earn up to a hundred times their salary overseas.

Professor Gordon Williams OBE, has concentrated his efforts in Ethiopia where he has lived for the last seven years. He was heavily involved with the Addis Ababa Fistula Hospital, which was established by American missionary doctors Reginald and Catherine Hamlin in 1974 for the treatment of vesico-vaginal fistulae (VVF). Patients with VVF and severe urinary incontinence (secondary to obstructed labour or sexual abuse) if untreated, are often rendered outcasts from their communities. Professor Williams’ gave a superb presentation on his former pioneering work at the fistula hospital and the holistic approach to patient management, reflected by patients’ extensive mental, physical and social rehabilitation pre and post-operatively. His team’s work has undeniably transformed the lives of thousands of women. Yet as Gordon reaches the end of his career, there is no natural successor in place.

Mr Ru McDonough (consultant urologist, UK) has had a professional relationship with Zanzibar for two decades. The success of his charity HIPZ (Health Improvement Project Zanzibar) (@HIPZ_UK) is testament to his engagement with the health ministry in identifying realistic local healthcare needs. They have proposed incentivised, financially viable, strategic projections for growth with quantifiable outcome measures. HIPZ has leased two rural hospitals from the government and successfully initiated ambitious restructuring and building projects.

We also heard from Dr Frank Bright from Kilimanjaro Christian Medical Centre (KCMC) and Suzie Venn and Phil Thomas (from the UK) about their biennial urological education workshops at the KCMC where core surgical skills are taught to urologists from all over East Africa.

All four endeavours are praiseworthy and clearly have had a positive impact on the lives of many patients. The opportunity to listen firsthand to their accounts and visit local facilities, prompted informal discussions amongst peers around how we as professionals might best support sustained healthcare improvement projects overseas.

Is it, for example, sufficient to visit intermittently in an attempt to clear the backlog of difficult cases that have accumulated since the last such trip? Should we be focusing our efforts on providing complex surgical procedures when many hospitals are lacking in basic supplies/sanitation?  How can we work transparently with governments on a wider scale to improve healthcare provision and health promotion?

Ultimately, it may be that these issues are so inextricably linked with a country’s financial performance that meaningful progress will only result from improving economies and political stability. Perhaps our primary aim should be to support solutions generated by and within individual communities and countries.

 


In this short video, Mark Speakman (President of BAUS) discusses the healthcare system of the island, particularly the work of the charity HIPZ. Correction: ‘The healthcare spending per capita in 2013 was $8500 in the USA, $3400 in the UK and $30 in Zanzibar!

 

Main Hospital in Zanzibar

 


Conference attendees

 


President of Zanzibar Dr. Ali Mohamed Shein addressing RSM delegates

 

Clarissa Martyn-Hemphill – Core Trainee, Whipp’s Cross – @Cmartynhemphill

Dominic Hodgson – Consultant Urologist, Portsmouth – @hodgson_dominic

 

 

A #RadOnc Movember

The #RadOnc Journal Club continued its success in Movember with over 700 tweets from 60 participants in a three-day discussion on smoking and prostate cancer radiation treatment outcomes. Thanks to the generosity of the BJUI (@BJUIJournal) and Prof. Prokar Dasgupta (@prokarurol), the study of a large retrospective cohort of localized prostate cancer patients who received external beam radiation treatment from Memorial Sloan Kettering (@sloan _kettering) was open-access and engaged a wide audience.

Background discussion started Friday and covered a variety of topics including limiting treatment toxicity:

Sharing best practices on the role of radiation treatment from around the world:

The state of tobacco use:

And smoking cessation from an interdisciplinary audience:

On Sunday, the community came together for a live discussion with study author Emily Steinberger (@easteinberger). Participants explored roles for radiation treatment and the reduction of side effects including hypofractionated treatment and current guidelines for IMRT:


Practice patterns in patient assessment stressed the importance of a tobacco history. These encounters created an opportunity for cessation counselling as opposed to guiding treatment decisions while recognizing the threat of information overload.


The conversation then moved to the study. Results showed current-smokers had a higher PSA relapse rate (HR 1.37 compared to former or non-smokers), more distant metastases (DM-free survival 72% vs. 87% in never-smokers), and higher cancer specific mortality (HR 2.25). There were a few surprises including finding no significant differences based on pack-years smoked and that only current as opposed to former smoking status mattered.

Study strengths included a large cohort of 2358 similarly-treated patients; 91% having documented smoking histories. Limitations included the retrospective design, especially considering the long natural history of prostate cancer and risk of development of confounding comorbidities. Also an important reminder:

Conversations concluded with considerations for future practice:


Research:


With a little #RadOnc humor in-between.

We recognize the quality contributions from all members of our community. For their leadership during this chat, congratulations to Dr. Jay Detsky (@JayDetsky) and Dr. Mohammad Alfayez (@alfayezmo) who received the Jerry Maguire Award for their evidence-based tweets. (“Show me the data!!!”) The Francis Peabody award went to Dr. Jonathan Livergant (@jpil) and Dr. Jarad Martin (@DocJarad) for the best clinical tweets. We will be looking forward to more lively conversations in the New Year!

The #RadOnc Journal Club was first proposed at the Yale Department of Therapeutic Radiology in April 2014 to leverage published evidence and stimulate discussion on key topics in radiation oncology. It became part of Radiation Nation – a community founded by Dr. Matthew Katz (@subatomicdoc) dedicated to improve cancer care through online collaborative conversations on education, medical practice, and quality and safety improvement for patients, caregivers, and medical professionals. Interest grew globally and in September, where we bridged cultural divides by encouraging conversations in multiple languages. Today, we routinely have participation from over 5 countries during the #RadOnc Journal Club and on Radiation Nation blog.

Ian Pereira is an R2 resident in Radiation Oncology at Queen’s University, Kingston, Canada. He believes that education is a basis for progress in health and care, and is interested in leveraging new technologies including social media in medical education.

 

A big thank you to all our 2014 reviewers

Peer review is a critical part of the publishing process for any major journal and BJUI is no exception. We are fortunate to have a large and dedicated team of expert reviewers who give up their time and energy to help us bring you the best articles in the field.

In 2014, BJUI used 2059 different peer reviewers and we are extremely grateful to them all for their time and expertise.

The reviewers listed below are the most prolific and fastest of our 2014 reviewers and are our “Top Reviewers” for the year.

The full list of reviewers can be accessed by clicking the button at the bottom.

Hashim Ahmed Misop Han Ashley Ross
Kamran Ahmed Paul Hegarty Morgan Roupret
Peter Albertsen Jose Karam Paul Russo
Conrad Bishop Nathan Lawrentschuk Majid Shabbir
Matthew Bultitude Stacy Loeb Jay Smith
Ben Challacombe Yair Lotan Mark Soloway
Justin Collins Graeme MacLennan Mark Speakman
Ithaar Derweesh Declan Murphy Houston Thompson
Stephen Freedland Richard Popert Nick Watkin
Giorgio Gandaglia Abhay Rane
Khurshid Guru Amrith Rao

 

BJUI Peer Reviewers 2014

 

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