Faculty Bibliography

OBJECTIVE: To analyze the association between US urology department Twitter presence and U.S. News and World Report (USNWR) reputation scores, to examine the content, informational value, and intended audience of these platforms, and to identify objectives for Twitter use. METHODS: We identified Twitter accounts for the top 50 ranked hospitals for urology in the 2016-2017 USNWR. Correlation coefficients were calculated between Twitter metrics (number of followers, following, tweets, and Klout influence scores) with USNWR reputation scores. We also performed a detailed content analysis of urology department tweets during a 6 month period to characterize the content. Finally, we distributed a survey to the urology department accounts via Twitter inquiring who administers the content and their objectives for Twitter use. RESULTS: Among 42 scored urology departments with Twitter accounts, the median number of followers, following, and tweets were 337, 193 and 115, respectively. All of these Twitter metrics had a statistically significant positive correlation with reputation scores (p<0.05). Content analyses revealed that most tweets were about conferences, education, and publications, targeting the general public or urological community. Survey results revealed that the primary reason for twitter use among urology departments was visibility/reputation, and urologists are considered the most important target audience. CONCLUSIONS: There is statistically significant correlation between Twitter activity and USNWR reputation scores for urology departments. Our results suggest that Twitter provides a novel mechanism for urology departments to communicate about academic and educational topics, and social media engagement can enhance reputation.

PURPOSE OF REVIEW: The goal of this article is to discuss current genomic testing options in localized prostate cancer. RECENT FINDINGS: There are multiple genomic tests currently available for men with localized prostate cancer. Prolaris, OncotypeDx, and Decipher can all be tested using biopsy tissue. Prolaris and Decipher are also available for men undergoing radical prostatectomy to predict subsequent disease progression. SUMMARY: The Prolaris cell cycle progression score measured on biopsy predicts the risk of prostate cancer death in 10 years with conservative management, whereas, the primary endpoint for the OncotypeDx genomic prostate score is the risk of adverse disease at radical prostatectomy. Decipher measures genome-wide RNA expression, and its Genomic Classifier signature was initially designed to predict the risk of metastasis for men with adverse disease at radical prostatectomy, and more recently, a biopsy version was released. Recently, Decipher signatures predicting prostate cancer cell lineage and postoperative radiation sensitivity have also been described. Any of these tests can be used by men with localized prostate cancer to provide additional prognostic risk stratification to aid in treatment decisions.

OBJECTIVE: To explore and identify factors that influence physicians' decisions while monitoring patients with prostate cancer on active surveillance (AS). SUBJECTS AND METHODS: A purposive sampling strategy was used to identify physicians treating prostate cancer from diverse clinical backgrounds and geographic areas across the USA. We conducted 24 in-depth interviews from July to December 2015, until thematic saturation was reached. The Applied Thematic Analysis framework was used to guide data collection and analysis. Interview transcripts were reviewed and coded independently by two researchers. Matrix analysis and NVivo software were used for organization and further analysis. RESULTS: Eight key themes emerged to explain variation in AS monitoring: (i) physician comfort with AS; (ii) protocol selection; (iii) beliefs about the utility and quality of testing; (iv) years of experience and exposure to AS during training; (v) concerns about inflicting 'harm'; (vi) patient characteristics; (vii) patient preferences; and (viii) financial incentives. CONCLUSION: These qualitative data reveal which factors influence physicians who manage patients on AS. There is tension between providing standardized care while also considering individual patients' needs and health status. Additional education on AS is needed during urology training and continuing medical education. Future research is needed to empirically understand whether any specific protocol is superior to tailored, individualized care.

OBJECTIVE: To assess whether a correlation exists between newsworthiness (Altmetric score) and scientific impact markers, such as citation analysis, impact factors, and levels of evidence. METHODS: The top five most cited articles for the year 2014 and 2015 from the top 10 ranking urology journals (Scientific Impact Group) were identified. The top 50 articles each in 2014 and 2015 were identified from Altmetric support based on media activity (Media Impact Group). We determined the number of citations that these articles received in the scientific literature, and calculated correlations between citations with Altmetric scores. RESULTS: In the Scientific Impact Group, the mean number of citations per article was 37.6, and the most highly cited articles were oncology guidelines. The mean Altmetric score in these articles was 14.8. There was a weak positive correlation between citations and Altmetric score (rs = 0.35, 95% confidence interval 0.16-0.52, P < 0.001). In the Media Impact Group, the mean Altmetric score was 121.1 and most widely shared articles all related to sexual medicine. In this group, the mean number of citations was 9.7 and there was a weak negative correlation between Altmetric score and citations (rs = -0.20, P = 0.046). CONCLUSION: The top articles based on Altmetric scores were not highly cited, suggesting that publications receiving the most media attention may not be the most scientifically rigorous, or that this audience places greater value on different subjects than the scientific community.

Many patients diagnosed with cancer search for health information on the Web. We aimed to assess the quality and reliability of online health information on prostate cancer. Google, Yahoo, and Bing were searched for the term "prostate cancer." After selecting the most frequented websites, quality was measured by DISCERN score, JAMA benchmark criteria, and presence of HONcode certification. Popularity was assessed by Alexa tool, while accessibility, usability, and reliability were investigated by LIDA tool. Readability was analyzed by Flesch-Kincaid Reading Grade Level and Automated Readability Index. All 13 selected websites were rated as being of high quality according to the DISCERN instrument (76.5 +/- 2.6 out of 80 points). JAMA benchmark criteria were fulfilled by 87 % of websites, whereas only 37 % were certified by the HONcode. Median Alexa Traffic Rank was 2718 ranging from 7 to 679,038. Websites received 2.3 +/- 0.5 daily pageviews per visitor and users spent an average of 2 min 58 s +/- 39 sec on the website. Accessibility (92 +/- 5 %) and usability (92 +/- 3 %) scores were high and reliability (88 +/- 8 %) moderate according to the LIDA tool. Flesch-Kincaid Grade Level was 7.9 +/- 2.2, and Automated Readability Index was 7.5 +/- 2.4, rating the websites as fairly difficult to read. In conclusion, quality, accessibility, and usability of websites on prostate cancer provided a high rating in the current analysis. These findings are encouraging in view of the growing frequency of patients' access of health information online.

OBJECTIVES: To investigate how well the Gleason score in diagnostic needle biopsies predicted the Gleason score in a subsequent radical prostatectomy (RP) specimen before and after the 2005 International Society of Urological Pathology (ISUP) revision of Gleason grading, and if the recently proposed ISUP grades 1-5 (corresponding to Gleason scores 6, 3 + 4, 4 + 3, 8 and 9-10) better predict the RP grade. PATIENTS AND METHODS: All prostate cancers diagnosed in Sweden are reported to the National Prostate Cancer Register (NPCR). We analysed the Gleason scores and ISUP grades from the diagnostic biopsies and the RP specimens in 15 598 men in the NPCR who: were diagnosed between 2000 and 2012 with clinical stage T1-2 M0/X prostate cancer on needle biopsy; were aged