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Ten stories of 2012, part I




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It is now my turn to welcome you to the BJUI blog. We [the editorial team] hope that you will be as excited as we are about the future. For my first blog posts, I decided to recap the year 2012 in ten stories. These are topics that caught my attention in 2012, and are certainly not representative of what others might think as ‘important’. Nonetheless, I hope that you will find this curated collection of some interest, and maybe stir a little controversy or two. Happy 2013!

In no particular order, part 1 of 2:

+ The re-election of Barack Obama

The bottom line is that the Patient Protection and Affordable Care Act, AKA Obamacare, will happen. What does this mean for American Urologists? Read the excellent review article by Kirk Keagan and Dave Penson on this sweeping piece of legislation aimed at addressing health care costs and disparities. From the paper: “Perhaps most germane to urologists, the ACA will restrain revenues generated from ancillary services, such as in-office imaging and via a bolstered Stark law that will prohibit physicians from referring Medicare patients to a hospital in which they have an investment or ownership interest.” Word on the street is that the AUA is not too happy. Is America ready for Cheesecake medicine?

+ Is robot-assisted radical prostatectomy really better?

Against a background of Jim Hu’s landmark JAMA paper, we learned new things with respect to the robot-assisted (RARP) vs. open RP (ORP) polemic. First, objective data shows that RARP has overtaken ORP as the main surgical approach for prostate cancer in the U.S (Link)(Link). Second, perioperative outcomes of RARP are better (Link)(Link)(Link). Third, RARP costs more. Fourth, nobody knows for functional outcomes (Link)(Link)(Link). Either way, some people really seem to hate robotic surgery, with a vengeance.

+ PSA screening – the controversy that refuses to die…

2012 will be forever (well, at least for nerdy urologists) remembered as the year the USPSTF downgraded PSA screening to a ‘D’ recommendation. In case you live in a cave, that means that “the science shows that more men will be harmed by PSA screening than will benefit. The expected harms are greater than the small potential benefit.” Nice rebuttal by Carlsson et al from MSKCC here. Nonetheless, primary care providers don’t seem to care, as up to 43.9% of men above the age of 74 were still getting screened in 2010. Conversely, in an article emphatically subtitled ‘Less is More’, the evidence shows that the incidence of prostate cancer is, for the first time in decades, decreasing. Prostatectomists, better find something else to do (just trolling, no hate mail please).

+ PSA screening – the Twitter Wars

2012 was a breakthrough year for social media in Urology. In the past year, Twitter has gained considerable traction in our field, thanks to the presence of Tweet (and real world) leaders such as Matt Cooperberg, Tony Finelli, Alex Kutikov, Mike Leveridge, Stacy Loeb, our own Declan Murphy, Dave Penson, Maxine Sun and the self-proclaimed King of Twitter himself, Ben Davies. That said, December hosted some lively exchanges on PSA screening. It started with a nicely-written-yet-a-little-oversimplistic blog post and accompanying tweet by @CBayneMD in favour of PSA screening, which led to some epic jostling between @cooperberg_ucsf (pro-screening) and @kennylinafp (against screening, wrote the evidence review for the USPSTF), amongst others. @daviesbj summary here. Oh yeah, be sure to follow me on Twitter as well as the BJUI itself.

+ The PIVOT trial

Timothy Wilt, of USPSTF fame, strikes again. Here’s one man who won’t be getting a Christmas card from an Urologist anytime soon. After representing the USPSTF at the 2012 AUA Town Hall  Meeting (brave), Wilt et al’s PIVOT trial demonstrated that “among men with localized prostate cancer detected during the early era of PSA testing, radical prostatectomy did not significantly reduce all-cause or prostate-cancer mortality, as compared with observation, through at least 12 years of follow-up.” Despite its many limitations and flaws (read Ian Thompson’s excellent accompanying editorial here), the lay press suggested in light of this trial that RP does not save lives.

Quoc-Dien Trinh
@qdtrinh

 

Quoc-Dien Trinh is a minimally-invasive urologist and co-director of the Cancer Prognostics and Health Outcomes Unit. His research focuses on patterns of care, costs and outcomes in prostate cancer treatment.

 

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  1. Declan Murphy
    Very nice Quoc! Other stories that caught my eye included Nathan Sheet's JAMA paper (https://www.ncbi.nlm.nih.gov/pubmed/22511689) looking at the costs of new forms of radiotherapy. I think IMRT practitioners have been happy to watch the debate on the costs of robotic surgery from the sidelines hoping the spotlight doesn't turn on them. I think it now is. The real issue of costs associated with localised prostate cancer should really focus on the crazy costs of new-fangled radiotherapy (evidence-free zone). Robotic surgery looks like amazing value up against proton therapy and even IMRT +ADT. Myself and Matt Cooperberg editorialised about this in Nature Reviews Urology a few months back (https://www.ncbi.nlm.nih.gov/pubmed/22750953). Would like to see some really good comparative effectiveness research on localised prostate cancer #newyearswish
  2. Henry Woo
    Patience Declan. This is only part 1 of 2 for Quoc's blog on 2012. Hope you haven't stolen his thunder! :)

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