Faculty Bibliography

OBJECTIVE:In countries with widespread prostate cancer screening there has been strong stage migration, but little is known about changes within clinical risk categories. Such data are important for the proper interpretation of studies that recruited cases in an earlier era. The purpose of this study was to examine stage migration between and within clinical risk categories. MATERIAL AND METHODS/METHODS:Using the population-based National Prostate Cancer Register (NPCR) of Sweden, changes in the distribution of prostate-specific antigen (PSA), Gleason score, tumor stage and volume overall between and within clinical risk categories were examined in 120 228 prostate cancer cases diagnosed from 1998 to 2011. RESULTS:Between 1998 and 2011, there was a two-fold increase in the proportion of low-risk prostate cancer (stage T1/T2, Gleason score 2-6 and PSA <10 ng/ml), from 14% to 28%, and more than a two-fold decrease in the proportion of metastatic disease, from 25% to 11%. The proportion of men in the low-risk category with T1c tumors increased two-fold, from 36% to 71%, and PSA levels between 4 and 6 ng/ml increased from 24% to 38%; T2 tumors decreased from 39% to 20% and PSA between 8 and 10 ng/ml decreased from 24% to 15%. The proportion of men with less than 25% of cores involved with cancer increased from 41% to 52% between 2003-2006 and 2007-2011. CONCLUSIONS:Low-risk cases today have substantially lower tumor volume and PSA levels than low-risk cases diagnosed in 1998, indicating that outcomes in studies that recruited cases in previous decades represent worst case scenarios.

CONTEXT: Although prostate cancer (PCa) screening reduces the incidence of advanced disease and mortality, trade-offs include overdiagnosis and resultant overtreatment. OBJECTIVE: To review primary data on PCa overdiagnosis and overtreatment. EVIDENCE ACQUISITION: Electronic searches were conducted in Cochrane Central Register of Controlled Trials, PubMed, and Embase from inception to July 2013 for original articles on PCa overdiagnosis and overtreatment. Supplemental articles were identified through hand searches. EVIDENCE SYNTHESIS: The lead-time and excess-incidence approaches are the main ways used to estimate overdiagnosis in epidemiological studies, with estimates varying widely. The estimated number of PCa cases needed to be diagnosed to save a life has ranged from 48 down to 5 with increasing follow-up. In clinical studies, generally lower rates of overdiagnosis have been reported based on the frequency of low-grade minimal tumors at radical prostatectomy (1.7-46.8%). Autopsy studies have reported PCa in 18.5-38.5%, although not all are low grade or low volume. Factors influencing overdiagnosis include the study population, screening protocol, and background incidence, limiting generalizability between settings. Reported rates of overtreatment vary widely in the literature, although contemporary international studies suggest increasing use of conservative management. CONCLUSIONS: Epidemiological, clinical, and autopsy studies have been used to examine PCa overdiagnosis, with estimates ranging widely from 1.7% to 67%. Correspondingly, estimates of overtreatment vary widely based on patient features and may be declining internationally. Careful patient selection for screening and reducing overtreatment are important to preserve the benefits and reduce the downstream harms of prostate-specific antigen testing. Because all of these estimates are extremely population and context specific, this must be considered when using these data to inform policy. PATIENT SUMMARY: Screening reduces spread and death from prostate cancer (PCa) but overdiagnoses some low-risk tumors that may not have caused harm. Because treatment has potential side effects, it is critical that not all patients with PCa receive aggressive treatment.

PURPOSE: Genome-wide association studies have identified an increasing number of single nucleotide polymorphisms (SNPs) associated with prostate cancer risk. Some of these same genetic variants are also associated with serum PSA levels and lower urinary tract symptoms, raising the question whether the SNPs are truly biomarkers for prostate cancer or simply lead to detection bias. We therefore sought to determine whether the prostate cancer risk SNPs are more strongly associated with tumor volume or prostate volume. MATERIALS AND METHODS: The genotypes of 38 validated prostate cancer risk SNPs were determined in 1,321 Caucasian men who underwent radical prostatectomy. Univariate and multivariate analyses were performed to compare the relationship between SNP frequency, total prostate volume and tumor volume. RESULTS: On multivariate analysis, 2 SNPs on chromosome 8q24, rs16901979 (A) (p=0.01) and rs6983267 (G) (p=0.02), were significantly associated with increased tumor volume. In contrast, rs17632542 (T) (p=0.02), near the PSA gene on 19q13, was associated with significantly lower tumor volume, and rs10788160 (A) (p=0.01) on 10q26 was associated with a significantly larger prostate volume. CONCLUSIONS: Analyses of 38 prostate cancer risk SNPs demonstrates a significant association between several SNPs on chromosome 8q24 and increased tumor volume but not prostate volume, suggesting they are bona fide markers for prostate cancer susceptibility and possibly more aggressive disease. Meanwhile, other "prostate cancer risk SNPs" are associated with PSA levels and either increased prostate volume or decreased tumor volume, suggesting a detection bias due to their phenotypic influence.

OBJECTIVE: The use of social media in medicine has greatly expanded in recent years The objective of this study was to characterize the use of social media among members of the American Urological Association (AUA) PATIENTS AND METHODS: In December 2012-January 2013, the AUA emailed a survey with 34 questions on social media use to 2000 randomly selected urologists and 2047 resident/fellow members Additional data was collected from Symplur analytics on social media utilization surrounding the AUA annual meeting in May 2013 RESULTS: A total of 382 (9.4%) surveys were completed, indicating 74% of responders had an online social media account The most commonly used social media platforms were Facebook (93%), followed in descending order by LinkedIn (46%), Twitter (36%) and Google+ (26%) Age younger than 40 was an important predictor of social media use (83% vs. 56%), with greater uptake among residents/fellows compared to attending (86% vs. 66%) Only 28% of respondents used social media partly or entirely for professional purposes During the AUA 2013 meeting, there were >5,000 tweets from >600 distinct contributors. CONCLUSION: As of early 2013, among respondents to an email survey, most urologists and urology trainees used some form of social media, and its use in urology conferences has greatly expanded.