Prostate Screening Results Anticipated From Urology Meeting

Kate Johnson

April 29, 2016

SAN DIEGO — Significant updates on practice-changing clinical trial results in prostate cancer screening, male sexual dysfunction, and female incontinence will be presented during two late-breaking sessions here at the American Urological Association (AUA) 2016 Annual Meeting.

"Studies featured in the late-breaking abstracts are thought to be of either very high quality or of major potential significance," said Victor Nitti, MD, from the NYU Langone Medical Center in New York City and the AUA Office of Education.

A re-evaluation of prostate-specific antigen testing rates from the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial is likely to make some headlines, and much-anticipated results from a randomized trial comparing neuromodulation with intradetrusor injection of onabotulinumtoxinA for refractory overactive bladder will offer clear guidance.

In addition, one entire late-breaking session will be dedicated to high-intensity focused ultrasound, which, although recently approved by the US Food and Drug Administration (FDA), is the subject of much debate, Dr Nitti reported.

"People clearly want to know about it, so that's the point of the plenary. While the FDA has deemed it to be safe and approved it for tissue ablation, it does not have a specific indication for the treatment of prostate cancer. The bottom line is that people are going to want to use it for that reason," he said.

"The FDA doesn't specify whether it's for benign or malignant disease; it's a bit vague, like saying you can drive this car but we're not going to tell you how to drive it," said Manoj Monga, MD, from the Cleveland Clinic, who is secretary of the AUA.

"There's a great need to educate our physicians on what the indications are in other countries, what their experience has been, what the limitations of the technology are, and what should be the appropriate expectations to set for patients who choose this therapy," he pointed out.

Clinical Guidelines

Clinical guidelines are what the 22,000 AUA members "value the most," Dr Monga explained. To that end, four new clinical guidance documents — three guidelines and a consensus statement — will be presented at the meeting.

"We have put them together in collaboration with other societies to try to find common ground and provide uniform information for providers," he said. Guidelines on the surgical management of kidney and ureteral stones were developed in collaboration with the Endourological Society.

Guidelines on the management of urethral strictures were developed in collaboration with the Society for Genitourinary Reconstructive Surgeons.

Guidelines on the management of nonmuscle invasive bladder cancer were developed in collaboration with the Society for Urologic Oncology.

And guidance on the role for MRI fusion in patients with a previous negative prostate biopsy was developed in collaboration with the Society of Abdominal Radiology.

"They will get released in a variety of formats," Dr Monga said. "First are plenary sessions to give a short summary of the findings, but there will also be coordinated publications in the Journal of Urology, a specialized AUA guidelines app, which I think is probably one of the more common ways people are using our guidelines, and guideline-specific courses that people can attend at the meeting."

Highlights

This year there will be more surgical education than in previous years, with a distinct focus on the prevention and anticipation of errors.

"We're expanding the traditional live surgery sessions to 2 days instead of 1, and there will be a new Setbacks and Operative Solutions — or SOS — session with edited video segments of things you'd rather not have happen in the OR, followed by panel discussions of how to anticipate and prevent them," Dr Monga explained.

And a new session called Court's in Session will take the format of a mock trial. Real malpractice attorneys will examine injury to the ureter during stone extraction, pregnancy after vasectomy, and rapidly advancing prostate cancer under surveillance.

"We'll be trying to get participants to learn through a legal lens, so to speak," Dr Monga explained. "They'll not only see how to avoid problems, but also how to counsel patients appropriately beforehand. Not that we're trying to encourage people to craft patient conversations with litigation in mind, but it gives them a different perspective."

A key speaker this year — Tom Lue, MD, from the University of California at San Francisco — will trace the path of sexual dysfunction treatment from its early beginnings to the future, which he predicts is stem cell therapy. And Patrick Soon-Shiong, MD, from the University of California at Los Angeles, will discuss the cancer moonshot as it applies to urology.

Finally, the surgeon who performed the world's first penile transplant last year, Andre van der Merwe, MD, head of urology at the Stellenbosch University in Cape Town, South Africa, will deliver a plenary lecture entitled Penile Transplantation: The Future Is Today.

"As sites gear up to do this procedure in the United States, this is an important topic," Dr Monga pointed out.

Around 16,000 attendees are expected at the conference. "If they attend for the full 5 days," he said, "they can actually earn up to 64 CME credits, so it's a really compacted opportunity to gain a lot of knowledge."

Dr Nitti and Dr Monga have disclosed no relevant financial relationships.

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