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EAU14 – ESOU citations

Have You Read This?…A bibliography of cited papers on prostate cancer at the Joint Meeting of The European Section of Oncological Surgery (ESOU) and EORTC—Genito-Urinary Cancer Group.

At the BJUI, as with any journal, the published articles are peer reviewed and editorial board reviewed.  The process starts with a triage editor who screens for basic methodology, importance of the topic, and potential for citation factor impact.  The top 50% are sent for full peerreview, which includes 3 reviewers (ad hoc or from the board).  Full review is organized by an associated editor who assigns (and then begs) the 3 reviewers to complete their task, and then makes a final recommendation to the editor in chief.  I could go on about this interesting process, but the point is that a published paper is often really just the opinion of 4-5 experts in the field, including the editor.  Once published, however, papers are then kept alive by repeated citation and meeting discussions, or disappear intoPubMed and forgotten. Future papers that cite a previously published paper will help the impact factor of that journal.  But what about congress events and their cited works?  At the EAU 2014, as with any congress, key opinion leaders are asked to give talks, make arguments, and prove their points.  They may do so with personal experiences, videosor modern abstract quotes, but often they cite recent peer review publications.  At the joint session meeting of the ESOU and EORTC-GUCG, I noted the following cited publications from the prostate cancer talks.  How many have you read so far?

On the topic of circulating tumor cells (CTCs) in prostate cancer, Professor S. Osanto of Leiden (NL) cited (partial citations):

1. Hanahan D et al. The hallmarks of cancer. Cell 2000
2. Klein CA.  Cancer.  The metastasis cascade.  Science 2008.
3. Gerlinger M et al.  Intratumor heterogeneity and branched evolution revealed by multiregionsequencing.  NEJM 2012
4. Allard WJ et al. Tumor cells circulate in the peripheral blood of all major carcinomas but not in healthy subjects or patients with nonmalignant diseases. ClinCancer Research 2004
5. de Bono JS et al. Circulating tumor cells predict survival benefit from treatment in metastatic castration-resistant prostate cancer. Clin Cancer Research 2008
6. Attard G et al. Characterization of ERG, AR, and PTEN gene status in circulating tumor cells from patients with castration-resistant prostate cancer.  Cancer Res 2009.
7. Cristofanilli M. Circulating tumor cells, disease progression, and survival in metastatic breast cancer.  NEJM  2004.
8. Goldkorn A et al. Circulating tumor cell counts are prognostic of overall survival in Southwest Oncology Group trial S0421: A phase III trial of docetaxel with or without atrasentan for metastatic castration-resistantprostate cancer.  J Clin Oncol 2014.

From these papers, the conclusions were many and included: 1) CTS can detect early relapse, genomic signatures, target identification, and treatment decisions, 2) surrogate marker for response, and 3) emergence of resistance.

Next, the focus shifted to the popular technical points and outcomes of open versus minimally invasive radical prostatectomy.  Bernardo Rocco (IT) cited the following papers in support of robot-assisted radical prostatectomy for high risk PCa

9. Yuh et al.  The role of robot-assisted radical prostatectomy and pelvic lymph node dissection in themanagement of high-risk prostate cancer: A systematic Review. Eur Urol 2014
10. Montorsi et al. Best practices in robot-assisted radical prostatectomy: recommendations of the Pasadena Consensus Panel. Eur Urol 2012.
11. Silberstein JL et al. A case-mix adjusted comparison of early oncological o utcomes of open and robotic prostatectomy performed by experienced high volume surgeons.  BJU Int 2013.
12. Hu JC. Comparative effectiveness of robot-assisted versus open radical prostate cancer control.  Eur Urol2014
13. Ploussard G et al. Pelvic lymph node dissection during robot-assisted radical prostatectomy efficacy, limitations, and complications—a systematic review of the literature. Eur Urol 2013.
14. Prasad SM et al.  Variations in surgeon volume and use of pelvic lymph node dissection with open and minimally invasive radical prostatectomy. Urology 2008
15. Cooperberg MR et al. Adequacy of lymphadenectomy among men undergoing robot-assisted laparoscopic radical prostatectomy.   BJU Int 2010
16. Feifer AH et al. Temporal trends and predictors of pelvic lymph node dissection in open or minimally invasive radical prostatectomy. Cancer 2011
17. Ficarra et al. The European Association of Urology Robotic Urology Section (ERUS) survey of robot-assisted radical prostatectomy (RARP).  BJU Int 2013.
18. Gandaglia G et al. Is robot-assisted radical prostatectomy safe in men with high-risk prostate cancer? Assessment of perioperative outcomes, positive surgical margins, and use of additional cancer treatments.  J Endourol 2014.
19. Ou Y.C. et al. The trifecta outcome in 300 consecutive cases of robotic-assisted laparoscopic radical prostatectomy according to D’Amico risk criteria.  EJSO 2013.
20. Lavery HJ et al. Nerve-sparing robotic prostatectomy in preoperatively high-risk patients is safe and efficacious.  Urol Oncol 2012.
21. Montorsi F. Robotic prostatectomy for high-risk prostate cancer: translating the evidence into lessons for clinical practice.  Eur Urol 2014

From these citations, the conclusions were that: 1) RP is an adequate treatment for high risk prostate cancer, 2) robotic approach is not inferior to open as far as oncological outcome, 3) lymph node template and yield are adequate in experienced hands in RARP setting, 4) functional outcome after RARP in high risk is preserved, nerve sparing is feasible in selected patients, and 5) Costs of RARP are related to surgical volume and experience.  So there you see a typical meeting presentation—13 papers in 15 minutes plus additional commentary and abstract data.

Next, Prof. Declan Murphy presented the Australian experience with robot-assisted RP for cT3a prostate cancer.  With overlapping topics, it was no surprised some papers were recited from above including #9, #12,He cited:

22. Evans et al. Patterns of care for men diagnosed with prostate cancer in Victoria from 2008-2011.  Med JAust 2013
23. Wilt T et al. Radical prostatectomy versus observation for localized prostate cancer. NEJM 2012
24. Connoly SS et al. Radical prostatectomy as the initial step in multimodal therapy for men with high-risk localized prostate cancer: initial experience of 160 men.  BJU Int 2012.

From these citations, Prof. Murphy concluded that: 1) radical prostatectomy has minimal benefit for low risk men, especially older, 2) The biggest benefit is in high risk disease, 3) active surveillance is being embraced in Australia, 4) RARP is safe and effective with similar outcomes to ORP, 5) RARP has less positive margins and less additional therapy compared to ORP 6) extended PLND not limited by robotic approach.

Prof. Axel Heidenreich then took the opposite point of view in support of open radical prostatectomy.  Despite the references above, he pointed out that there is still no long-term data for robotic prostatectomy, although not proving that with pathologic staging we would expect anything different.  Cost of course can be quite better for open.  He also cited for papers showing positive margins of < 12% in pT3 disease, compared to many other open and minimally invasive series where it is usually 25% and higher. Repeat citations: #9. He also cited:

25. Robertson C et al. Relative effectiveness of robot-assisted and standard laparoscopic prostatectomy as alternatives to open radical prostatectomy for treatment of localized prostate cancer: a systematic review and mixed treatment comparison meta-analysis.  BJUI 2013.
26. Vora AA et al.  Robot-assisted prostatectomy and open radical retropubic prostatectomy for locally-advanced prostate cancer: multi-institution comparison of oncologic outcomes.  Prostate Int 2013
27. Punnen S et al. How does robot-assisted radical prostatectomy (RARP) compare with open surgery in men with high-risk prostate cancer? BJU Int 2013
28. Sooriakumaran P et al. A multinational, multi-institutional study comparing positive surgical margin rates among 22393 open, laparoscopic, and robot-assiste radical prostatectomy patients. Eur Urol2014
29. Alemozzafar M et al. Benchmarks for operative outcomes of robotic and open radical prostatectomy: results from the health professionals follow-up study.Eur Urol 2014
30. Davison BJ et al Prospective comparison of the impact of robotic-assisted laparoscopic radical prostatectomy versus open radical prostatectomy on health-related quality of life and decision regret. Can J Urol 2014
31. Bolenz C et al.    Costs of radical prostatectomy for prostate cancer: a systematic review.  Eur Urol 2014

From these citations, he concluded that 1) open radical prostatectomy is still viable, 2) not needed for low risk, 3) lack of long-term data for RARP, 4) no inferiority in terms of functional and oncological outcome, or quality of life, 5) better cost effectiveness, especially with median case load of < 300 RP’s per year.

I hope you find this reading list useful.  Could you transfer such a bibliography to an effective review article?  Probably not, and we can ask associate editor Quoc Trinh to comment or write a separate blog on the emerging field of systematic reviews, such as the multiple cited reference 9 by Yuh et al.  A systematic review needs to conform to standards such as the PRISMA guidelines—see –which is “an evidence-based minimum set of items for reporting in systematic reviews and meta-analyses.  Therefore we have an interesting difference in standards between a meeting presentation and a formal peer-reviewed systematic review—the former can hand-pick articles to make a point, while the latter must be thorough, transparent, and reproducible.

John W. Davis, MD  FACS

Houston, Texas (USA)

Associate Editor, BJUI



2 replies
  1. Declan Murphy
    Declan Murphy says:

    This is a great overview John – fantastic effort to record all those references! One of the key reasons I go to plenary sessions at EAU and AUA is to hear from experts and see what papers they are citing. I used to jot all these down in the program book but inevitably I now just end up with a bunch of photos in my phone. Can you please do this for all plenary sessions??!!

  2. Prokar Dasgupta
    Prokar Dasgupta says:

    PLOS one have championed the concept of “peer review out there” for many years.
    Despite its high acceptance rate the impact factor remained steady and the criticisms of process gradually faded away. What many will not know is that at the BJUI we have a hybrid open access (OA) policy so as grant funding bodies insist on OA more and more, we are ready to face the wider community of readers beyond the few expert reviewers as John states above.
    I have also been trying to encourage colleagues to comment under the articles as they appear on
    We would love to hear from you.

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