Friday, May 30, 2014

AUA Best Abstracts from the Residents

The American Urological Assocation (AUA) Annual Meeting is a wonderful opportunity for urology residents, trainees and medical students to showcase the hard-work and research they have performed, as well as to meet other urologists, learn about the field and see cutting edge data.  Each of the residents below attended this year's AUA Meeting in Orlando, Florida to present individual research.  In addition to presenting their own work, they attended scientific sessions and interacted with other researchers.  Each resident has selected their own "Highlights" from the meeting and discuss them below.

To read the entire abstract follow the links below:
For podium presentations (PD5-), click here.
For poster presentations (MP10-), click here.


Nilay Gandhi, MD; Senior Assistant (U3) Resident

**MP34-07: Differential Gene Expression In Responsive Versus Recurrent Non-muscle Invasive High-grade Urothelial Carcinomas After Induction BCG. Philip Ho*, Daniel Willis, Houston, TX, Saad Aldousari, Kuwait, Kuwait, Charles Guo, Colin Dinney, Xifeng Wu, Ashish Kamat, Houston, TX

Interesting research assessing mRNA differential expression identifying significant increase in the expression of genes involved with cell cycle progression, cell death/necrosis/apoptosis, and migration of antigen presenting cells. Extremely important to identify predictors of BCG response given likelihood of patient side effects and up to 40% failure rate after induction BCG.
**Also selected by Max Kates (below)

MP55-13: INTRAOPERATIVE BLOOD TRANSFUSION DURING RADICAL CYSTECTOMY INCREASES THE RISK OF DEATH FROM BLADDER CANCER COMPARED TO POSTOPERATIVE TRANSFUSION.  E. Jason Abel*, Madison, WI, Brian J. Linder, Rochester, MN, Tracy M. Downs, Tyler M. Bauman, Madison, WI, R. Houston Thompson, Prabin Thapa, Rochester, MN, Octavia N. Devon, Madison, WI, Robert F. Tarrell, Igor Frank, Matthew K. Tollefson, Rochester, MN, David F. Jarrard, Madison, WI, Stephen A. Boorjian, Rochester, MN

Assessment of 360 patients identifying 30% increased risk of death from bladder cancer in patients receiving intraoperative transfusion compared to those postoperatively. Also noted within older patients with more advanced stage disease. Critiques include likely multifactorial, requires stage for stage assessment to identify true clinical impact, no neoadjuvant chemo pts included.

Debasish Sundi, MD; Senior Assistant (U3) Resident

MP61-19: A novel role of the transcription factor TCF21 as a suppressor of bladder cancer metastasis.  Sima Porten*, Beat Roth, Jonathan Melquist, Woonyoung Choi, Shanna Pretzsch, Jolanta Bondaruk, Charles Guo, Bogdan Czerniak, David McConkey, Colin Dinney, Houston, TX

The transcription factor TCF21 may serve as a mediator of the transition from local to metastatic urothelial cancer.  A number of studies focused at this year's AUA looked at gene expression in the transition from local, to invasive, to metastatic urothelial cancer.  I am intrigued by this transition, and a better understanding of these gene transcripts, like the transciption factor in this presentation, may improve our understanding (and therefore treatment) of urothelial cancer metastases.

**PD34-08: Disparities in survival for California men with prosate cancer are more associated with socioeconomics than either race or insurance status. Thenappan Chandrasekar*, Kari Fish, Christopher Evans, Ralph DeVere White, Marc Dall'Era, Sacramento, CA

The podium is one of the three reports of Black race as an independent risk factor for adverse oncologic outcomes after radical prostatectomy after controlling for SES.  The other two include a 15 year-old study of SEER from our colleagues at UCSF and work done at Johns Hopkins by Farzana Faisal (below).
**Also selected by Farzana Faisal (below).

Mark W. Ball, MD; Lab Resident

MP59-18 Chronic Kidney Disease Due to Surgery (CKD-S): Relative Rates of Progression and Survival. Sevag Demirjian*, Cleveland, OH, Brian Lane, Grand Rapids, MI, Ithaar Derweesh, La Jolla, CA, Toshio Takagi, Amr Fergany, Steven Campbell, Cleveland, OH

This study evaluated progression of renal failure in a cohort of patients with GFR < 60 after surgery by classifying as  surgical chronic kidney diseaes (CKD) (normal  GFR before surgery) and medical CKD (low GFR before surgery) and a medical CKD only cohort. Overall patients with surgical CKD has less progression and increased overall survival compared to patients in either medical CKD cohort. This work bolsters previous work from the authors that shows a clear distinction between medical and surgical CKD.

MP54-20: Overall survival and renal function of partial and radical nephrectomy among older patients with localized renal cell carcinoma: multicenter study.  Jae Seung Chung*, Busan, Korea, Republic of, Seok Soo Byun, Sang Eun Lee, Sung Kyu Hong, Sang Chul Lee, Seongnam, Korea, Republic of, Chang Wook Jeong, Hyeon Hoe Kim, Cheol Kwak, Ja Hyeon Ku, Seoul, Korea, Republic of, Yong June Kim, Cheongju, Korea, Republic of, Seok Ho Kang, Sung Hoo Hong, Won Suk Choi, Seoul, Korea, Republic of

This multi-institutional study from Korea evaluated renal functional outcomes in patients >65 after radical and partial nephrecotmy. The authors found an increased incidence of new onset CKD in the RN cohort compared to partial nephrectomy (66.7 vs 26.3) but no difference in overall survival. Although not a perfect study and far from the whole story, this study addds another piece of evidence that may help define the ideal candidates for nephron-sparing surgery.

Jeffrey Tosoian, MD; Junior (U1) Resident

MP55-06: Prostate sparing cystectomy: 20 years single center experience.
Laura Mertens*, Richard Meijer, Remco de Vries, Jakko Nieuwenhuijzen, Henk van der Poel, Axel Bex, Bas van Rhijn, Wim Meinhardt, Simon Horenblas. Amsterdam, Netherlands.

These authors reported their experience over 20 years with performing prostate-sparing cystectomy (PSC) for muscle-invasive bladder cancer (MIBC) or refractory high risk non-MIBC, as opposed to the conventional radical cystoprostatectomy (RC), which is the generally accepted standard of care. They describe excellent disease-specific survival of 76.2% and 66.5% at 2 and 5 years, respectively. Functional outcomes were similarly impressive, with daytime continence, nighttime continence, and erectile function maintained in 96.2%, 81.9%, and 89.7%, respectively. 

As a junior resident who continues to learn about both standard and non-standard therapies, this abstract caught my attention because it diverged from my expectations. I am eager to compare these findings with the more conventional cystoprostatectomy. The authors note one local recurrence in the remnant prostatic epithelium, and I would be interested to learn more about this patient’s subsequent course. If this recurrence could presumably have been avoided by performing conventional RC, that raises an important question: as both patients and urologic oncologists, are we willing to risk one unnecessary recurrence for the possibility of improved functionality? I suspect the answer may vary significantly based on who you ask.

MP27-13: The impact on the type of ureteral stent to patient symptoms using USSQ : A prospective randomized controlled study.  Hyoungkeun Park*, Sangrak Bae, Sunghyun Paick, Hyunwoo Kim, Jutae Seo, Joonchul Kim, Wonhee Park, Yongsoo Lho, Hyeonggon Kim. Seoul, Korea.

These authors performed a randomized controlled trial comparing stent-related symptoms in patients treated with a conventional double-j ureteral stent versus a newly emerging stent which contains a softer distal end.  While the softer distal tip stents were designed with hopes of improving stent-related symptoms, hey ultimately found no significant differences between the two stent groups in reported urinary symptoms or pain as reported by the visual analogue pain scale.

This abstract stood out to me because it investigates what any urologic resident will tell you is a very common problem. In addition to being prevalent, stent pain is rather peculiar by nature. From patient to patient, stent-related symptoms can vary from completely absent to moderately severe, and our treatment options are largely limited. Studies have shown that alpha-blockers (e.g. tamsulosin) reduce stent-related symptoms, and others have suggested that additional agents such as anticholinergics (e.g. oxybutynin) or urinary tract analgesics (e.g. phenazopyradine) may improve patient symptoms. Regardless, these authors investigated a mechanical advancement in stent material with aims of decreasing discomfort. While their findings were negative, this abstract can help guide subsequent trials aimed at reducing symptoms associated with the all-too-common problem of stent pain.

Max Kates, MD; Junior (U1) Resident

For me, the theme of this years AUA was personalized medicine.  Nowhere was this more apparent than with bladder cancer, where we are heading towards a treatment paradigm of therapy tailored towards  tumor biology.  The following 3 abstracts fit squarely in this trend.

MP28-14: Targeting HER2 with Trastuzumab-DM1 (T-DM1) in HER2-overexpressing bladder cancer.  Tetsutaro Hayashi*, Wolfgang Jaeger, Igor Moskalev, Shannon Awrey, Na Li, Ladan Fazli, Vancouver, Canada, Wataru Yasui, Akio Matsubara, Hiroshima, Japan, Peter Black, Vancouver, Canada

In this study, the authors first identified HER2 overexpressing bladder cancer cell lines and then tested whether an agent targeting Her-2 had antitumor effects.  Bladder cancer has multiple tumor pathways, and this study gave insight into the future of bladder cancer care, where patients will be tested for protein expression, and their treatments will then be tailored to their specific species of bladder cancer.

MP34-14: Targeting epidermal growth factor receptor using photoimmunotherapy in the treatment of bladder cancer.  Sam Brancato*, Piyush Agarwal, Bethesda, MD

This study also foreshadowed the way medicine, oncology, and bladder cancer care will be  managed in the long-run.  Specific cell surface receptors on the urothelium that were upregulated in bladder malignancy were targeted using a monoclonal antibody that is bound to a flourescent dye, and targets in this case EGFR receptor.  A very unique technology will be interesting to follow as it moves beyond preclinical data.

MP34-07: Differential Gene Expression In Responsive Versus Recurrent Non-muscle Invasive High-grade Urothelial Carcinomas After Induction BCG.  Philip Ho*, Daniel Willis, Houston, TX, Saad Aldousari, Kuwait, Kuwait, Charles Guo, Colin Dinney, Xifeng Wu, Ashish Kamat, Houston, TX

The implications of this study is the BCG failure should be able to be identified prior to treatment by understanding the tumor's biology.  Treatment can then be tailored towards non BCG treatments in these refractory groups.  Ultimately,the tumor will provide a therapeutic blueprint for what will work in treating the cancer.

Hiten Patel, MD; Incoming Urology Resident

PD34-09: Does Prostate Cancer Gleason Pattern 3 Lack the Potential for Metastasis? Michael Vacchio*, Bo Xu, Diana Mehedint, Christine Murekeyisoni, Gissou Azabdaftari, James Mohler, Eric Kauffman, Buffalo, NY

The study provides further evidence that Gleason pattern 3 prostate cancer defined by the 2005 International Society of Urological Pathology guidelines lacks metastatic ability. It is important to note that tertiary pattern 4 or 5 was excluded. Although 1 of 451 patients had distant metastasis at a mean of 76 months, blinded pathologist re-review led to upgrading of the patient's prostatectomy specimen to Gleason 7 (12 of 18 men with biochemical failure who had negative margins were also upgraded).

PD31-03: Statin use and Survival after prostate cancer diagnosis in the Finnish Prostate Cancer Screening Trial.  Teemu Murtola*, Tampere, Finland, Liisa Määttänen, Kimmo Taari, Helsinki, Finland, Teuvo Tammela, Anssi Auvinen, Tampere, Finland

A dose-response relationship in statin use and prostate cancer mortality was observed among 6,220 men diagnosed with prostate cancer in the screening trial. The magnitude comparing users and non-users was impressive (HR 0.33 (0.23-0.49)) and supports more research into the relationship in the future. That being said, it is important to consider what the practical financial and side effect implications would be if the eventual debate is on widespread statin use as a preventative measure for men without high cholesterol - a group where the benefit, if any, is likely to be much lower.

Farzana Faisal, Medical Student

I found these two abstracts most interesting because they got me thinking about the research we are doing at Hopkins on racial disparities in prostate cancer.

PD34-08: Disparities in survival for California men with prostate cancer more associated with socioeconomics than either race or insurance status. Chandrasekar T, Fish K, Evans C, White RD, Dall'Era M.

These authors looked at over 360,000 men with PCa in the California Cancer Registry and found that SES, more so than race or insurance status, was the most important predictor of cancer specific survival and overall survival for men with localized or regional disease. These findings seem to contradict what we are showing with the Hopkins cohort - that AA race increases the risk of adverse pathology and BCR. However, a closer look at their data shows that AA race was still an independent predictor of survival outcomes even after adjusting for SES and insurance, and thus can be taken together with our findings to support the role of race as a biological contributor to tumor aggression and disparities in AA men.

MP78-06: Surgeon volume and disparities in postoperative complications among black men. Ruhotina N, Konijeti R, Reese S, Chung BL, Kibel A, Trinh QD, Chang SL.

This study concluded that lower access to high volume surgeons may be responsible for the increased risk of major Clavien complications post-prostatectomy for AA men. It's interesting to think about this factor of surgeon experience in terms of the increased risk of adverse pathology seen in AA men at prostatectomy, especially positive margins. This particular abstract prompted our group to start investigating the role of surgeon proficiency as factor in margin status and perhaps racial disparities.

Jason Cohen, Medical Student

PD34-01: Comparison of radical treatment and mortality in patients with non-metastatic prostate cancer in England and USA.  Ashwin Sachdeva*, Jan van der Meulen, Mark Emberton, Paul Cathcart, London, United Kingdom.

I thought it was interesting to see the differences in outcomes based on the variations in screening and treatment approaches.  It is something we do not get to see and is difficult to study with our own populations.

PD31-04: Do Environmental Factors Modify the Genetic Risk of Prostate Cancer? Stacy Loeb*, New York, NY, Sarah Peskoe, Corinne Joshu, Baltimore, MD, Wen-Yi Huang, Bethesda, MD, Richard Hayes, New York, NY, H. Ballentine Carter, William Isaacs, Elizabeth Platz, Baltimore, MD

This was an interesting talk on things that are often heard in the lay literature, with some corresponding data.  It also looks like it would lead to many research possibilities.


Read the entire abstracts:
For podium presentations (PD5-), click here.
For poster presentations (MP10-), click here.


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