AUA ’18: Experts pick this year’s key research

After last year’s San Diego event, the AUA annual meeting returns to the West Coast for this year’s gathering, which will be held in San Francisco. To help you sift the enormous scientific program and prioritize your schedule, the editors have called upon Urology Times’ editorial advisory board to identify the key research across multiple areas of the specialty. Click on any topic below to see the board’s abstract picks for that category.

As part of our comprehensive pre-meeting coverage, we also asked Urology Times blogger Henry Rosevear, MD, to name the 10 aspects of this year’s meeting he’s looking forward to most. Read his blog post here. In addition, “Practice Matters” columnist Robert A. Dowling, MD, outlined practice management and health policy sessions to watch for in a recent column. Read it here.

Safe travels!

Epidemiologic Trends

Prostate Cancer Markers/Surveillance

Localized Prostate Cancer Treatment

Advanced Prostate Cancer

Stone Disease

BPH/LUTS

Sexual Dysfunction

Infertility

Female Urology

J. Stuart Wolf, Jr., MD, professor of urology at Dell Medical School at The University of Texas, Austin, offers his take on epidemiologic trends/quality improvement and patient safety research from the meeting.

“At this year’s AUA annual meeting, urologists are expanding the ways in which we can improve the quality of care for our patients, looking beyond the typical methods of new treatments, better medications, etc. Patient education and identification of patients and situations ‘at risk’ can reduce postoperative emergency department and readmission rates. More thoughtful tracking of resource utilization can help us develop programs that more effectively manage our patients’ needs.”

Dr. Wolf’s abstract picks:

MP80-03: Causes of 30-days reoperation and readmissions post endourologic surgery: A national database analyses
Saad Hatahet

MP02-20: Readmission rates among patients discharged on the weekend: Are we facilitating good transitions of care?
Joseph Song

MP76-07: Utilization of an internet of things indoor GPS system and time-driven activity-based costing to enhance health care delivery in a urologic oncology clinic: A proof-of-principle
Aaron Laviana

MP86-04: Initial experience of a urology practice participating in an episode-based payment model for cancer care, the oncology care model (OCM)
Jeremy Shelton

PD28-05: Reducing preventable emergency department visits in post-urologic surgery patients in a safety net hospital
Jamal Nabhani

Additionally, in the area of epidemiologic trends/practice patterns and quality of life, here are noteworthy abstracts as selected by Peter C. Albertsen, MD, chief of urology at the University of Connecticut Health Center, Farmington:

MP44-08: Patterns of prescribing and monitoring testosterone replacement therapy among 40,081 users in British Columbia between 1997-2013
Jennifer Locke

MP44-10: The impact of the FDA testosterone supplementation therapy safety advisory on prescribing patterns
Valary Raup

MP44-13: Variable use of postoperative imaging following ureteroscopic stone treatment across diverse urology practices in Michigan
Casey Dauw

MP44-17: Clinical implication of a simple quantitative frailty assessment tool for prognosis in patients with urological cancers
Soma Osamu

MP51-01: Incremental adherence to guideline-based care is associated with improved survival among patients who undergo bladder preservation therapy or radical cystectomy for muscle-invasive bladder cancer
Nikhil Waingankar

MP51-14: Trends and predictors of active surveillance use in the United States for patients with clinical T1 renal masses
Hiren Patel

PD13-03: Advanced practice providers in urologic care in the United States
Raymond Fang

PD52-01: Association between radiation facility ownership and variation in prostate cancer treatment and spending
Tudor BorzaStacy Loeb, MD, MSc, assistant professor of urology at NYU Langone Health, New York, provides an overview of prostate cancer markers/surveillance research at the meeting:

“Active surveillance continues to be a major topic at AUA 2018. One of the key themes is the appropriateness of active surveillance for men with low-volume Gleason 3+4 disease. There are also numerous studies on the role of confirmatory testing with markers, magnetic resonance imaging, and/or biopsy on subsequent active surveillance outcomes.

“Prostate cancer markers are also a major theme at this year's AUA meeting. Several new serum, urine, and tissue markers are presented for possible use in prostate cancer diagnosis and prognostication. Other studies report on trends in use of commercially available tests for risk stratification and upfront management decisions. Finally, multiple studies examine the use of markers and/or imaging to predict oncologic outcomes after treatment.”

Dr. Loeb’s abstract picks:

MP12-15: National trends in the management of localized prostate cancer from a population-based cohort of privately insured patients
Simon Kim

MP12-20: Prostate health index and multiparametric magnetic resonance imaging to predict prostate cancer grade reclassification in active surveillance
Zeyad Schwen

MP17-03: Recurrence rates following testosterone therapy in a large clinical cohort of men with prostate cancer
Abraham Morgentaler

MP35-08: Incorporating prostate health index density, MRI, and prior negative biopsy status to improve the detection of clinically significant prostate cancer
Sasha Druskin

PD20-02: Can active surveillance really reduce the harms of psa testing, like the U.S. Preventative Services Task Force currently suggests? The PRIAS-study implicates caution
Frank-Jan Drost

PD20-04: Germline mutations in DNA repair genes are independent predictors of grade reclassification in active surveillance for prostate cancer patients
H. Ballentine Carter

PD20-08: The effect of selection and referral biases for the treatment of localized prostate cancer with surgery or radiation
Christopher Wallis

PD56-04: Validation of the decipher biopsy test to predict adverse pathology in men diagnosed with low and favorable intermediate risk prostate cancer
Brian Lane

PD60-05: Prospective validation of the IsoPSA^TM assay for detection of high grade prostate cancer
Eric KleinLeonard G. Gomella, MD, professor and chairman of urology at Thomas Jefferson University, Philadelphia, reviewed abstracts on localized prostate cancer treatment. Here is what he had to say about new research in this area:

“Although the uptake of robotic prostatectomy in North America and Europe is well established, other parts of the world are now increasing their experience. Many of the reports are from Asia, with many aspects of robotically assisted laparoscopic prostatectomy being evaluated in their unique populations.

“One paper of particular interest is comparing the PIVOT trial with other large national databases. Investigators from Michigan and Boston present a compelling argument that the unique patient population in the VA-based trial limits it generalizability to wider populations.”

Dr. Gomella’s abstract picks:

MP05-05: Assessing the external validity of the updated Prostate Cancer (PCa) Intervention versus Observation Trial (PIVOT)
Firas Abdollah

MP05-06: Establishment of the optimal follow-up schedule after radical prostatectomy
Kazuhiro Matsumoto

MP05-09: Duration of PSA surveillance after radical prostatectomy: A risk adapted approach
Mary E. Westerman

MP05-13: Association between MRI based urethral parameters and continence following robot assisted radical prostatectomy
Lawrence H C Kim

MP05-16: Salvage prostatectomy after focal therapy – single centre experience
Jaime Herrera-CaceresJ. Brantley Thrasher, MD, professor of urology at the University of Kansas Medical Center, Kansas City, discusses key research in advanced prostate cancer.

“This year at the AUA annual meeting, we will get an update on apalutamide (Erleada) and its effect on outcomes and quality of life in non-metastatic castration-resistant prostate cancer.

Additionally, we will get a better understanding of which patients with lymph node involvement after radical prostatectomy benefit most from adjuvant XRT + androgen deprivation therapy and how accurately positron emission tomography scans in these patients identify true lymph node recurrence burden.

Finally, expect to hear more on the effects of statins in men on ADT for advanced prostate cancer.”

Dr. Thrasher’s abstract picks:

PD10-02: Adjuvant radiation with androgen deprivation therapy for men with lymph node metastases following radical prostatectomy: Identifying men who benefit
Mohit Gupta

PD10-03: Assessing the under-estimation of nodal tumour burden by 68Ga-PSMA and 11c-choline PET/CT scan in patients treated with salvage lymph node dissection for nodal recurrence of prostate cancer: A large multi-institutional analysis
Nicola Fossati

PD10-11: Prostate-specific antigen (PSA) outcomes in patients (pts) with nonmetastatic castration-resistant prostate cancer (nmCRPC) treated with apalutamide (APA): results from phase III SPARTAN study
Eric J. Small

PD14-03: Prediction of treatment resistance under abiraterone and enzalutmide via detection of AR-V7 in peripheral whole blood of castration-resistant prostate cancer patients
Anna-Katherina Seitz

MP52-20: Patient reported outcomes (PROs) in SPARTAN, a phase 3, double-blind, randomized study of apalutamide (APA) plus androgen deprivation therapy (ADT) vs placebo plus ADT in men with nonmetastatic castration-resistant prostate cancer (nmCRPC)
Eric J. Small

MP87-07: Statin use is associated with improved prostate cancer-specific outcomes in white but not black men initiating androgen deprivation therapy
Emma Allott

MP87-15: Use of statins in combination with androgen deprivation therapy in patients with advanced prostate cancer: impact on oncological outcomes.
Natasza PosielskiAlternatives to opioid use, obstructed pyelonephritis, and residual fragments following ureteroscopy are among the topics of note in stone disease at this year’s meeting, says Brian R. Matlaga, MD, MPH, professor of urology at Johns Hopkins University School of Medicine, Baltimore. Here is what he had to say ahead of the meeting.

“Any urologist who places ureteral stents know that they can be painful for our patients, and oftentimes require the administration of narcotic agents to provide effective pain control. In recent years, though, our field has come to recognize that there may be an over-reliance on these narcotic agents, and furthermore that there are a host of deleterious consequences that may occur in the setting of narcotic utilization. Dr. Ryan Hsi’s group from Vanderbilt University will report on the persistent use of opioid agents following ureteroscopy, an area of particular concern (MP68-02).

“Dr. Kevan Sternberg’s group from the University of Vermont will describe an important study that they undertook that illustrates methodologies that permit an opioid-free approach to post-ureteroscopy pain management (PD53-07).

“In another effort to explore alternatives to opioid agents, Dr. Stephen Nakada’s group at the University of Wisconsin will report the findings of their randomized controlled trial evaluating the effectiveness of pre-treatment with tolterodine (Detrol) in an effort to control ureteral stent symptoms (PD35-06).

“In an effort to better understand emergency department utilization following ureteroscopy, the group from University of Michigan, led by Dr. John Hollingsworth, leveraged the exceedingly robust network of the Michigan Urological Surgery Improvement Collaborative (MUSIC) (PD53-01). This large-scale effort will allow the identification of care pathways, perhaps some of which leverage the aforementioned regimens, in an effort to optimize the patient experience.

“Other abstracts are focused on optimizing care pathways for patients with acute stone events. Obstructive pyelonephritis is a urologic emergency, with a known mortality associated with it. Dr. Ojas Shah’s group from Columbia University developed a protocol that reduces the variation in how such patients are managed in the acute setting (MP89-07).

“Dr. Peggy Pearle’s group at the University of Texas Southwestern Medical Center have previously reported on the rigorous CT-based detection of residual fragments following URS. At this meeting, they will be presenting on the fate of these residual fragments-an important concern for patient and physician alike (PD45-02).

“When it comes to percutaneous nephrolithotomy, some of the most experienced surgeons hail from China. Dr. Guohua Zeng’s group from Guangzhou will be reporting a multicenter, randomized controlled trial comparing super mini-PCNL to ureteroscopic stone treatment (PD 35-01).Steven A. Kaplan, MD, professor of urology at Icahn School of Medicine at Mount Sinai, New York, discusses BPH/LUTS research from this year’s meeting.

“This year’s abstracts examine innovative metrics assessing BPH therapies including discontinuation of medications, effects of surgical resection time on outcomes, post-hospital syndrome outcomes, and device manufacturing issues. In addition, the evolving experience using minimally invasive therapies such as UroLift, Rezum, stent and prostate arterial embolization, and surgical alternatives such as Aquablation and laser therapy will be presented.”

Dr. Kaplan’s abstract picks:

MP62-05: Outcomes assessment of Aquablation in prostates 50 to 80 mL in volume - a subgroup analysis from the phase III blinded randomized WATER study comparing Aquablation vs. Transurethral resection of the prostate for moderate-to-severe LUTS in men with BPH
Claus Roehrborn

MP73-02: Comparison of outcomes obtained after live operative surgical cases versus regular surgery. A single-centre experience with Green laser enucleation of the prostate
Vincent Misrai

MP73-03: The learning curve for green laser enucleation of the prostate (GreenLEP): a multi-institutional study of 584 cases
Enrique Rijo

MP73-09: Comparative effectiveness of benign prostate enlargement interventions at facilitating urologic medication discontinuation
Bradley Gill

PD59-03: Efficacy and safety of teverelix LA, a GnRH antagonist, in patients with benign prostatic hyperplasia (BPH) (clinical trial ep-24332t-a012)
Steven Kaplan

PD64-02: Real life experience with the Rezum system for benign prostatic hyperplasia
Daniel Mollengarden

PD64-03: The impact of surgical duration on transurethral resection of the prostate on complications: an analysis of NSQIP data
Christopher R. RiedingerIn the area of sexual dysfunction, here is what Arthur L. Burnett, II, MD, MBA, professor of urology at Johns Hopkins University School of Medicine, Baltimore, says to watch for:

“For this year’s AUA annual meeting, in the arena of sexual dysfunction, excitement surrounds several topics. In the area of penile prostheses, there are abstracts on surgical modifications, pain management in association with surgery, and infectious post-surgical complications including effects of microbial organisms.

“Increased emphasis is placed on outcomes of therapy, including quality of life and patient and partner satisfaction after treatments. Study and management of hypogonadism/testosterone deficiency remain at the forefront of interest, with particular consideration of testosterone deficiency risk factors.

“With regard to erectile dysfunction, further interest also is given to risk factors and possible subtypes. Continued interest is given to techniques and technologies to improve erectile function recovery outcomes after radical prostatectomy.”

Dr. Burnett’s abstract picks:

MP32-14: New findings regarding the timeline of microorganisms, infection severity and surgical intervention in inflatable penile prosthesis infections
Martin Gross

MP74-01: Sexual life satisfaction related to erectile function across different ages
Paolo Capogrosso

MP74-14: Nomogram using metabolic syndrome components to predict testosterone deficiency syndrome in men
Monique Novaes

MP74-17: Trajectories of erectile dysfunction subphenotypes in men with longstanding type I diabetes
Karandeep Singh

PD18-07: Effect of tissue sealing sheets on erectile function following robotic-assisted laparoscopic prostatectomy: Interim results of a randomized controlled trial
Shinichi YamashitaIn the field of infertility, James M. Hotaling, MD, MS, assistant professor of surgery (urology) at the University of Utah, Salt Lake City, singled out “descriptive studies on the use of anastrozole attempting to describe and prognosticate treatment response” as well as “large-scale collaborations examining male infertility such as the Andrology Research Consortium” as research to watch for.

Dr. Hotaling’s abstract picks:

MP19-01: Attributable cases of cancer and neurocognitive disorders in children in the united states based on paternal age
Yash S. Khandwala

MP19-09: Results of a North American survey on the characteristics of men presenting for infertility investigations: The Andrology Research Consortium

PD01-01: Surgically acquired sperm use for assisted reproductive technology: trends and perinatal outcomes, united states, 2004-2015
Jennifer Kawwass

PD01-12: Results of correction of subclinical varicoceles are similar to improvements seen after repair of palpable varicoceles
Nannan Thirumavalavan

PD09-08: No difference in semen parameters for infertile men who had early or late orchiopexies for undescended testis
Sangwoo LeemNew findings in the field of voiding dysfunction, neurourology, and female pelvic health will explore mesh use, botulinum toxin for overactive bladder, new devices and innovations, and nocturia, to name a few topics. Gopal H. Badlani, MD, professor of urology at Wake Forest Baptist Medical Center in Winston-Salem, NC, highlighted the following themes and abstracts in this area.

In studies of sling and mesh use, highlights include trends in use, the effect of the FDA’s warning in a large study (PD05-08), a single institution study showing revival of use, (MP75-02) and a decline in MAUDE registry complaints (PD05-03). A number of papers also deal with revision after removal of a portion or larger piece of mesh (MP75-02) and use of ultrasound in assessing mesh (MP75-08 and MP75-09).

Key abstracts on botulinum toxin discuss its long-term use (PD36-10), repeat injections (PD32-06), cumulative data (MP79-07), sensory aspect on functional MRI (PD04-01), less than ideal outcomes in Parkinson’s disease patients (PD36-01), and its safety in the geriatric population (MP79-08).

“The NIDDK-funded LURN [Lower Urinary Tract Dysfunction Research Network] study continues to generate data on male LUTS clusters (MP79-06), the relationship between post-void residual volume and UTI (MP79-05), and female LUTS clusters (PD50-04),” Dr. Badlani pointed out.

In the area of neuromodulation, key papers include a small study of safe use of lumbosacral MRI in patients with InterStim II (PD50-01), one discussing tined lead removal (MP79-17), and one exploring discontinuation of OAB meds after InterStim placement (MP75-17).

New innovations and devices includes: implantable percutaneous tibial nerve stimulation (MP75-18), use of telemedicine in spinal cord-injured patients (PD04-09), a pilot study of a new drug for stress urinary incontinence (PD05-09), radiofrequency ablation of the trigone (PD32-07), and a new beta-3 agonist for OAB (PD50-03).

Nocturia is a condition that “continues to confound patients and physicians,” Dr. Badlani said. “A lack of correlation with traditionally known causes (MP79-15), prevalence (PD32-03), and a trial of new drugs to treat it (MP79-12 and MP79-13)” are notable topics.