AUA 2018

AUA 2018: MRI Imaging - AUA Statement on its Use for Diagnosis, Staging, and Management

San Francisco, CA ( Peter Pinto, MD gave an overview of prostate multiparametric MRI (mpMRI). He began his talk discussing transrectal US (TRUS). Few urologists use TRUS to look for areas suspicious for cancer. 60% of ultrasound morphologically suspicious lesions are not cancer. Data from the PROMIS study, comparing TRUS to mpMRI for prostate cancer diagnosis, show that the sensitivity and specificity of TRUS is 48% and 74%, respectively. In contrast, the sensitivity and specificity of MRI is 93% and 89%, respectively. 

AUA 2018: Prostate Cancer: What PET to GET?

San Francisco, CA ( Thomas Hope, MD presented the different PET radiotracers available today for prostate cancer.  He began with the NaF PET/CT. This radiotracer has a good spatial resolution, high signal to the background with CT available for correlation, and has a short time from injection to imaging.

AUA 2018: Controversies in Urology: Kidney Cancer – Treatment with Thermal Ablation – CON

San Francisco, CA ( Ketan Badani, MD gave a talk on the disadvantages of thermal ablations for small renal masses (SRM). The first issue discussed was the problem of incomplete ablation. He began by describing a systematic review and metanalysis of laparoscopic vs. percutaneous cryotherapy for renal tumors.

AUA 2018: Controversies in Urology: Kidney Cancer – Treatment with Thermal Ablation – CON Rebuttal

San Francisco, CA ( Craig Rogers, MD gave a talk supporting Ketan Badani, MD in his opinion favoring partial nephrectomy (PN) over ablation for small renal masses (SRM). There is no doubt that PN is a more definitive therapy than ablation treatments. PN is the gold standard of treatment for clinical stage T1a disease. Robust data demonstrate excellent oncologic outcomes. PN allows complete pathological evaluation, and although it harbors the increased risk of urologic complications, it does not entail a higher risk of overall complications. 

AUA 2018: Controversies in Urology: Kidney Cancer – Treatment with Thermal Ablation – PRO Rebuttal

San Francisco, CA ( Houston Thompson, MD gave a presentation supporting the role of ablative treatments for small renal masses (SRM). In 2015 a paper from Mayo clinic was published in European urology comparing patients with clinical stage T1 treated with radiofrequency ablation or cryotherapy and partial nephrectomy. [1] This paper received substantial criticism with the main points being:

AUA 2018: Controversies in Urology: Kidney Cancer – Treatment with Thermal Ablation – PRO

San Francisco, CA ( Jaime Landman, MD gave a presentation advocating for the use of thermal ablation for small renal masses (SRM). SRM is a CT driven dilemma. Over the years, CT usage has risen exponentially. The usage of CT scans has jumped from 1995 to 2016 by 30-fold. Approximately 30% of renal masses are less than 3 cm, with the highest incidence among people aged 75-85.

AUA 2018: Can Active Surveillance Really Reduce the Harms of PSA Testing PRIAS-Study Implicates Caution

San Francisco, CA ( Prostate cancer screening using the prostate specific antigen (PSA) serum test has proven controversial in part due to the large burden of over diagnosis and over treatment. Active surveillance has been proposed as a way of mitigating the harms of PSA screening while retaining its potential benefits. In fact, the US Preventative Services Task Force has recently recommended selective PSA screening on the basis of such an approach. Dr Drost and colleagues report of data from the PRIAS study, focusing on the limitations of active surveillance (AS) to achieve such reductions in over treatment.