AUA 2019: Whitmore Lecture: Predicting the Future of Urologic Oncology from Knowledge of the Past
Dr. Smith reviewed past and current practices in this vast field, including management options, shifts in technique, and controversies, particularly in prostate cancer and small renal masses.
He briefly discussed PSA screening, its prevalence, and impact on prostate cancer incidence and outcomes. He discussed the advent of active surveillance as initial management of newly diagnosed prostate cancer, its role then and now. He poignantly discussed surgical approaches in urology, particularly in radical prostatectomy, and its evolution from an open operation to minimally invasive surgery. He showed his own astounding case numbers including close to 9,000 robotic prostatectomies following a whirlwind of open prostatectomies in his earlier career. Currently, more than 92% of prostatectomies performed in the United States are robotic.
He reviewed Australian and Swedish functional and oncologic studies which showed no significant superiority of the robotic approach for prostatectomy. He showed studies showing similar results for cystectomy and briefly touched on the higher costs associated with robotic surgery, but that despite lack of evidence clearly showing improved outcomes for robotic procedures, our field is moving toward the minimally invasive approach.
As part of his concluding statements, Dr. Smith discusses cytoreductive prostatectomy as an example to stress the importance of multidisciplinary care in complex malignancies, and that this will make a great impact as our field continues forward.
Presented by: Joseph A Smith, Jr. is William L. Bray Professor in the Department of Urologic Surgery at Vanderbilt University in Nashville, Tennessee
Written by: Selma Masic, MD, Urologic Oncology Fellow (SUO), Fox Chase Cancer Center, @selmasic at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois