Faculty Bibliography

Global usage of the social media (SoME) has increased exponentially. Facebook has close to 2.4 billion users, Twitter 330 million, YouTube 2 billion viewers each month, Instagram 1 billion active users, and LinkedIn 310 million users. This represents increases of 75%, 16%, 90%, 500%, and 19% respectively for these platforms over the past five years (1).

BACKGROUND:Prospective evidence supports active surveillance/watchful waiting (AS/WW) as an efficacious management option for low-risk prostate cancer that avoids potential treatment toxicity. AS/WW schedules require regular follow-up and adherence, and it is unknown to what extent patient socioeconomic status (SES) may impact management decisions for AS/WW. We sought to determine whether AS/WW use in the United States differs according to patient SES. DESIGN/METHODS:Using the Surveillance, Epidemiology, and End Results Prostate with AS/WW Database, all adult men diagnosed with localized low-risk prostate cancer (clinical T1-T2a, Gleason 6, and prostate-specific antigen <10 ng/mL) and managed with either AS/WW, radical prostatectomy, or radiotherapy were identified between 2010 and 2015. SES tertile was measured by the validated Yost Index (low: 0-10,901; middle: 10,904-11,469; high: 11,470-11,827). AS/WW trends were defined across SES tertiles from 2010 to 2015. Logistic multivariable regression defined adjusted odds ratios (aOR) for receipt of AS/WW by SES tertile. RESULTS:<0.001). By 2015, likelihood of AS/WW became comparable among the middle vs. high SES tertiles (aOR 0.96, 95% confidence interval (CI): 0.83-1.11, P = 0.55), but remained lower among the low vs. high SES tertile (aOR 0.73, 95% CI: 0.64-0.83, P < 0.001). CONCLUSIONS:AS/WW use for low-risk prostate cancer in the US differs by SES. Despite increases in AS/WW across SES from 2010 to 2015, patients from low SES received significantly lower rates of AS/WW compared with higher SES groups. SES may therefore influence management decisions, where factors associated with low SES might act as a barrier to AS/WW, and may need to be addressed to reduce any disproportionate risk of unnecessary treatment to lower SES patients.

OBJECTIVE:To provide the first comprehensive analysis of the Twitter-verse amongst academic urologists and programs in North America. METHODS:Using national accreditation and individual program websites, all active urology residency programs (USA & Canada) and academic Urology faculty at these programs were identified. Demographic data for each program (AUA section, resident class size) and physician (title, fellowship training, Scopus H-index and citations) were documented. Twitter metrics (Twitter handle, date joined, # tweets, # followers, # following, likes) for programs and physicians were catalogued (data capture: March-April 2019). Descriptive analyses and temporal trends in Twitter utilization amongst programs and physician were assessed. Multivariable (MV) logistic regression was used to identify predictors of Twitter use. RESULTS:156 academic programs (143 USA, 13 Canada) and 2214 academic faculty (2015 USA, 199 Canada) were identified. Twitter utilization is currently 49.3% and 34.1% amongst programs and physicians, respectively, and continues to increase. On MV analysis, programs with 3-5 residents/year and programs with a higher percentage of faculty Twitter engagement were more likely to have Twitter accounts. From a physician perspective, those with fellowship training, lower academic rank (clinical instructor, assistant professor, associate professor vs. professor) and higher H-indices were more likely to have individual Twitter accounts. CONCLUSION/CONCLUSIONS:There is a steady increase in Twitter engagement amongst Urology programs and academic physicians. Faculty Twitter utilization is an important driver of program Twitter engagement. Twitter SoMe activity is strongly associated with academic productivity, and may in fact drive academic metrics. Within Urology, SoMe presence appears to be proportional to academic activity.

Introduction: Despite substantial evidence on the impact of prostate cancer treatment on sexual function and sexual quality of life for men, there is limited research on the effect that this has on the sexual quality of life of partners. A better understanding of partners' sexual concerns will enable support of mutuality in couples' sexual relationships in PCa survivorship.
Objective(s): To perform a content analysis of posts by female partners to an online prostate cancer community.
Method(s): Inspire is a web-based social platform containing numerous communities about different health topics, which patients and caregivers can use to share information and support. The Inspire UsTOO Prostate Cancer Online Support & Discussion Community is one of the many disease-specific communities, which currently has more than 20,000 members. Through a data use agreement, we obtained anonymized text from postings to the community by female caregivers. Posts were manually reviewed to identify content related to sexual health, and qualitative analysis was performed to identify key themes.
Result(s): There were many posts by women to the online prostate cancer community about sexual issues related to their partner's diagnosis and treatment. Table 1 shows key themes and sample quotes. Partners expressed that intimacy was more important than receptive intercourse, particularly during a stressful time dealing with a cancer diagnosis. Without intimacy, women expressed feelings of grief and isolation. Sexual health was also tied into women's evolving role as a caregiver, requiring time spent to plan ahead for sexual activity as well as research into management options to improve sexual function for their partner.
Conclusion(s): Data from online health communities provide a unique window into the lived experience of patients and their families. Sexual issues resulting from prostate cancer treatment have a significant impact on female partners. Lack of intimacy and changes in the sexual relationship can result in significant feelings of isolation and grief for female partners. [Formula presented] Disclosure: Work supported by industry: no.
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The #ILookLikeAUrologist hashtag has been widely used on Twitter by a large global audience to promote diversity and inclusion in urology. According to the 2018 American Urological Association census, only 9.2% of practicing urologists are female and 16% are non-Caucasian. Social media have been used in other medical disciplines to promote diversity and form networks for gender and racial minorities. We studied the hashtag #ILookLikeAUrologist, started to promote diversity and inclusion in urology, to determine if it had any signs of a community of practice. Over the 4 yr since its inception, there have been 3694 tweets using the hashtag #ILookLikeAUrologist. The discussion had 1348 unique contributors, hailing from 35 countries on six continents. There were 8,156,051 impressions, highlighting a wide potential reach for the discussion. In a random 25% sample of original tweets, the main themes were gender representation, followed by personal narratives and camaraderie. Most contributors were practicing urologists, followed by urology trainees, other physicians, and professional organizations. Although most posts were authored by women, men represented nearly a quarter of individual contributors. The #ILookLikeAUrologist hashtag has been widely used by a large global audience in urology. Future research is warranted to examine the impact of digital communities of practice on outcomes such as fostering collaboration, providing mentorship, and reducing burnout.
Patient Summary: The #ILookLikeAUrologist hashtag has been widely used on Twitter by a large global audience to promote diversity and inclusion in urology.
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Introduction: Current guidelines recommend active surveillance (AS) as the preferred strategy for men with low-risk prostate cancer (PCa). AS involves serial testing to monitor the disease, and curative intervention is offered if the disease progresses. Studies show significant heterogeneity regarding testing frequency and when AS is discontinued.
Objective(s): To identify factors clinicians consider when decreasing/stopping AS for PCa.
Method(s): This qualitative study used data from semi-structured interviews with clinicians who monitor men on AS. Purposive sampling was used to ensure geographic variation in the U.S. Data collection continued until thematic saturation was achieved. Audio-recorded interviews with clinicians were transcribed verbatim and imported into Atlas.ti for data management and analysis. Framework analysis guided coding and identification of themes. Two researchers coded all transcripts independently, met to discuss, and reached consensus. Results and
Conclusion(s): Of the 24 clinicians, 83% were urologists representing 11 states, 92% were male, and 62% were white. Clinicians reported their experiences with either decreasing/stopping AS (Fig. 1, overleaf). Life expectancy, considering age and comorbidities, was the dominant theme influencing the decision to decrease/stop AS. Generally, clinicians did not have a specific age for when they would consider decreasing/stopping AS, but one clinician felt that 75 years should be the cut-off. The fear of missing the window of curability or being sued could limit clinicians' willingness to decrease/stop AS. One clinician's patient reported him to the medical board when he refused to do a rectal exam that was not clinically needed. Clinicians also mentioned situations where men stop showing up, due to work or transportation issues, or say they want to stop because of biopsy fatigue. These findings suggest that clinicians make decisions about changing AS in response to both clinical and pragmatic concerns. As AS use increases, additional recommendations are needed to guide decisions about decreasing/stopping AS. Disclosure of interest: None declared
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Active surveillance is now the recommended management option for low-risk prostate cancer. In this lecture we will discuss trends in use of active surveillance worldwide, optimal patient selection and monitoring. For men with intermediate- to high-risk localized prostate cancer, radical prostatectomy remains a gold standard treatment option. We will discuss recent trends in the surgical management of localized prostate cancer

The use of social media in medicine has rapidly increased. Social networks are used by clinicians for many purposes, including clinical case discussions, professional networking, advertising their practice, and patient education. Researchers are using social media for recruitment and dissemination of research, and as a source of data. Patients are also using social media as a source of information on health conditions, although there is a significant amount of misinformation. In this lecture, wewill discuss the pros and cons of social media use by clinicians, researchers and patients