Andrew Stephenson

@siadaneshmand @IUuro @nabiladra @SBoorjian @pcvblack @uroegg @drphil_urology @kellystratton @LuciaNappi4 @Testiscancer @GU_BigWhacks Excellent work. Transformative.

SEMS trial finally published! ⬆️data RPLND for early Stage II Seminoma is efficacious w/ min short & long term morbidity. Collaborators @IUuro @nabiladra @SBoorjian @pcvblack @uroegg @drphil_urology @kellystratton @LuciaNappi4 @Testiscancer @GU_BigWhacks pubmed.ncbi.nlm.nih.gov/36913642/

@dr_coops @uroegg @KeithKow @RobertReiterMD @auvinen_anssi @MA_Preston Important point re: marker+/MRI-. If pretest probability very high, a negative test (i.e. MRI) may not alter post-test probability all that much. Still favor biopsy in high risk pts despite neg MRI - especially if one doesn’t have expert MRI reviewer.

@uroegg @KeithKow @RobertReiterMD @auvinen_anssi @MA_Preston +1 for all of above. I'm a big fan of NSAIDs (not abx!) too, esp if prior neg bx. Personally have used a lot of ExoDx since Covid since it's super convenient as a home urine test, but it's dealer's choice for liquid test... But if marker + and MRI - I'll think about systematic.

Testing contemporary #prostatecancer screening in a fantastic population based RCT #ProScreen ⁦@auvinen_anssi⁩ #eau23

@ChapinMD @uroegg @KeithKow @RobertReiterMD @dr_coops @auvinen_anssi @MA_Preston Great approach / philosophy. Off-ramps => repeat PSA, free:total, 4K, select MDX, mpMRI I do use PCPT risk calc in almost all pts - estimate risk of important cancer. If > 10%, MRI +/- biopsy warranted.

@uroegg @KeithKow @RobertReiterMD @dr_coops @auvinen_anssi @MA_Preston I do similar. Use select MDX quite a bit. But risk assessment and pairing down seems to make sense. Always go back to “what would I want for me”

@dr_coops @urogeek @KeithKow @uroegg @chrisfilson_uro @mleapman @JAMANetworkOpen @AmerUrological @dartmouth Look at PROTECT and recent data from Ontario Canada => in the end, almost all GG1 get treated, sooner or later. I doubt the treatment rate among pts on AS is largely physician driven. Lots of progress to be made. @UroOncMD

@urogeek @KeithKow @uroegg @chrisfilson_uro @mleapman @JAMANetworkOpen @AmerUrological @dartmouth C’mon, name names! 😆

Trends and Variation in Use of #Activesurveillance for Low-risk #Prostatecancer, now out in @JAMANetworkOpen ja.ma/3SK4uuB. Data from over 20K men in the @AmerUrological #AQUARegistry: Nat'l rates of AS up from 26% to 60% since 2014, but variation remains extreme:

@jimhumd Single dose FQ with IM gent (or IM 3rd gen ceph). Negligible sepsis rate.

What is the duration of oral antibiotic prophylaxis that you typically give for transrectal prostate biopsy? Understandably, an IM may be given just before biopsy for augmented prophylaxis.

@UroOncMD @DrAndrewLoblaw @KariTikkinen @CanUrolAssoc @JUrology @AmerUrological @UofTSurgery @UofTUrology @LoebStacy @auvinen_anssi @TurkuUroOnc @Uroweb @Phil_Violette Honestly, I am amazed survival differences were observed among a cohort of low-risk pts who were treated compared to another cohort of whom 60% received treatment (albeit delayed). Maybe GG1 is actually a cancer! Fascinating and provocative. @uroegg @dr_coops

@DrAndrewLoblaw @KariTikkinen @CanUrolAssoc @JUrology @AmerUrological @UofTSurgery @UofTUrology @LoebStacy @auvinen_anssi @TurkuUroOnc @Uroweb @Phil_Violette Generalizability versus protocol study environment. Reassuring if you ask me

How many discontinue #ActiveSurveillance for low-grade #ProstateCancer? In a population-based study from Ontario 🇨🇦 the answer is about 50% at 5 years and about two thirds at 10 years Cancer-specific survival was 98% at 10 years auajournals.org/doi/epdf/10.10… #EBM @CanUrolAssoc

@AmarUKishan Equally relevant for surgical planning purposes. Perhaps this explains the conflicting data re: LND in RALRP. Important anatomical regions may be unaddressed surgically in many LN dissections. Exciting times for potential refinements in treatment.

Detailed topographic analysis of PSMA-defined recurrences after RP in 226 men suggests a majority of recurrences occur inferiorly and posteriorly. Potentially major implications for post-operative RT contouring.

@UroOncMD The initial challenge was convincing patients & clinicians to buy into AS. The challenge now is to identify reliable indicators for when AS should be abandoned. Much of this is also patient-driven anxiety and fatigue. Unfortunately, these data are similar to many others.

Some limitations but real data, from multi center, various providers across different practices

@BEkidneystone @MGHUrology @hollenbeck1971 @urochiefmlb @AFeldmanMD Well-deserved. Congratulations 👏🏻

Welcome to @MGHUrology @hollenbeck1971 !!!

@JGrummet @uroegg @vipurology @daviesbj A reliable BCR endpoint for focal therapy is likely to be elusive => so many confounders with intact and untreated prostate.

@uroegg @vipurology @daviesbj @RealProstateDoc Need a BCR definition for focal therapy that incorporates PSAD proportional to volume of untreated gland.

Is everyone now defining biochemical recurrence as 2 consecutive PSA values ≥0.03 ng/mL after surgery? Frustrating to see different institutions set different definitions. #UroSoMe #medtwitter #prostatecancer @daviesbj @uroegg

@daviesbj @uroegg @vipurology The value of a test is based in part on the pre-test probability. We published a paper in EurUrol showing that 0.05 is adequate for pts with pT3b, pN1, GG4-5. A more rigorous and specific definition is needed (e.g. 0.2 and rising) for non-high risk. NOTE: All open RP pts.

@uroegg @vipurology @RealProstateDoc And the necessity of ultra sensitive PSAs is lost on me (altho I published not one but two papers lauding it)

@wandering_gu @smkaff @siadaneshmand @uroegg The AUA/ASCO GCT guidelines did not recognize RPLND as standard option until publication of the SEMS and German trials. Both of these P2 trials provide compelling evidence that it should be a consideration in non bulky CS II seminoma, as primary or CS I relapse. Stay tuned.

Is this currently being offered as a treatment option off study? #GU23 @smkaff @siadaneshmand @uroegg

@Testiscancer @LuciaNappi4 @siadaneshmand Agree 100%. Relapse does not equate to mortality in GCT as in other malignancies. It’s about preventing GCT deaths with the least long-term collateral damage. So many have been banging this drum for years.

The Question @LuciaNappi4 posed is the most important one in early GCT. Rephrased, why should PFS matter? ES pts are destined to be cured, but live long with consequences of what we give to cure them? @siadaneshmand showed big reduction in chemo with primary RPLND

@dr_coops @UCSFCancer @uroegg @adamkibel_uro @aleberlin2 Great work!

Thank you to all who joined us for a truly all-star, multiD, int'l conference at @ucsfcancer during #GU23 to discuss nomenclature for GG1 #prostatecancer. Incredibly high yield afternoon and hopefully a path forward. @uroegg @adamkibel_uro @aleberlin2

Saw this nice gesture on social media in light of the tragedy at Michigan State - the house united.

@dr_coops Agreed!

Sortof-rebuttal from D’Amico re AS for “favorable IR”. Race / ancestry should not be an exclusion for surveillance! #gu23

@wandering_gu At the heart of this is universal access (public option or single-payer system).

Framework for mitigating disparities in bladder cancer #GU23

@SFreedlandMD @DrPaulNguyen In a way, this supports stepwise sequential treatment intensification for aggressive PC.

Great data from @DrPaulNguyen showing adding #abiraterone and #apalutamide for 6 months to #ADT for salvage post-RP #radiation results in modest improved #PFS and #MFS but results very impressive for PSA >0.5. Question: Do we need both drugs or is one drug alone enough? #GU23

@wandering_gu @vidit_sharma_ @CJStimson Huge.

Financial toxicity, value based care ➡️ hugely important topics to address. Must see talks by @vidit_sharma_ and @CJStimson #GU23

@mcg_urology @mkterris @MCG_AUG Congratulations!

Announced today by Dean David Hess at the annual State of the College Address. @MCG_AUG