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EAU 2018

AUA 2018: Journal of Urology: Top Papers in Bladder and Renal Cancer

San Francisco, CA (UroToday.com) Badrinath Konety, MD, the editor responsible for bladder and kidney related papers at the Journal of Urology, presented the top articles in these areas in the past year from the journal. While not comprehensive, he felt they highlighted the most impactful of the papers. There were a total of 43 of these papers in 2017 and 35 in 2018. There were 5 that had the highest social media activity:

Campbell et al (JU Sep 2017)1 – Renal mass guidelines
Chang et al (JU Sep 2017)4 – NMIBC guidelines
Kiss et al. (JU Dec 2017)2 – Stent vs. Neph tube at time of RC
Chandrasekar et al (JU Sep 2017)3 – AS for cystic renal masses
Uzosike et al. (JU Sep 2017)5 – Growth Kinetics of small renal masses

While the first two were guideline statements, the other three were important articles. He touched on all 3 later.  Major papers, in his opinion, were as follows:

Spatz et al. (JU Feb 2018)6 – PSMA is encoded in the FOLH1 gene, which is found in tumor vascular endothelium. While mainly assessed in PCa, these authors looked at it in RCC. Oncocytoma was negative for PSMA. Clear cell and chromophobe RCC were grossly positive, while papillary RCC demonstrated low expression. Its expression is associated with worse survival, particularly in pT2+ disease.

Wallace et al. (JU Oct 2017)7 – based on 5 urinary mRNA markers identified in a discovery and validation cohort, they developed a short in-clinic assay that had 77% sensitivity, 90% specificity for hematuria and 77% specificity for BCa surveillance. Kavalieris et al,8 in follow-up, had a 95% sensitivity in identifying intermediate/high risk NMIBC and 97% specificity.

Kiss et al. (JU Dec 2017)2 – in this simple study, they evaluated the risk of upper tract recurrence in patients with pre-operative hydronephrosis prior to radical cystectomy (all had negative margins). Patients managed with nephrostomy tube had 0 upper tract recurrence, while patients managed with stents had 13%. 

Shah et al. (JU Nov 2017)9 – while not specifically bladder or kidney related, this study highlights the role of physicians and urologists on the opioid dependence epidemic. In particular, stone patients were at highest risk of being opioid dependent.

Chandrasekar et al (JU Sep 2017)3 – this study represented the largest series of AS for complex renal cysts published. Take-home message – 367 patients, 1 patient died of disease and 2 developed metastases. In patients with Bosniak 2F or 3 cysts and no genetic predilection, none developed metastases or died of disease.

There were obviously more impactful papers, but these are the ones he chose to highlight. 

Presented by: Badrinath Konety, MD, MBA, University of Minnesota

References:
1. Campbell S, Uzzo RG, Allaf ME, Bass EB, Cadeddu JA, Chang A, Clark PE, Davis BJ, Derweesh IH, Giambarresi L, Gervais DA, Hu SL, Lane BR, Leibovich BC, Pierorazio PM. Renal Mass and Localized Renal Cancer: AUA Guideline. J Urol. 2017 Sep;198(3):520-529. doi: 10.1016/j.juro.2017.04.100. Epub 2017 May 4.
2. Kiss B, Furrer MA, Wuethrich PY, Burkhard FC, Thalmann GN, Roth B. Stenting Prior to Cystectomy is an Independent Risk Factor for Upper Urinary Tract Recurrence. J Urol. 2017 Dec;198(6):1263-1268. doi: 10.1016/j.juro.2017.06.020. Epub 2017 Jun 8.
3. Chandrasekar T, Ahmad AE, Fadaak K, Jhaveri K, Bhatt JR, Jewett MAS, Finelli A. Natural History of Complex Renal Cysts: Clinical Evidence Supporting Active Surveillance. J Urol. 2017 Sep 20. pii: S0022-5347(17)77564-7. doi: 10.1016/j.juro.2017.09.078. [Epub ahead of print]
4. Chang SS, Bochner BH, Chou R, Dreicer R, Kamat AM, Lerner SP, Lotan Y, Meeks JJ, Michalski JM, Morgan TM, Quale DZ, Rosenberg JE, Zietman AL, Holzbeierlein JM. Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer: AUA/ASCO/ASTRO/SUO Guideline. J Urol. 2017 Sep;198(3):552-559. doi: 10.1016/j.juro.2017.04.086. Epub 2017 Apr 26.
5. Uzosike AC et al. Growth Kinetics of Small Renal Masses on c: Variability and Results from the DISSRM Registry. J Urol. 2017 Sep 23. pii: S0022-5347(17)77614-8. doi: 10.1016/j.juro.2017.09.087. [Epub ahead of print]
6. Spatz S, Tolkach Y, Jung K, Stephan C, Busch J, Ralla B, Rabien A, Feldmann G, Brossart P, Bundschuh RA, Ahmadzadehfar H, Essler M, Toma M, Müller SC, Ellinger J, Hauser S, Kristiansen G. Comprehensive Evaluation of Prostate Specific Membrane Antigen Expression in the Vasculature of Renal Tumors: Implications for Imaging Studies and Prognostic Role. J Urol. 2018 Feb;199(2):370-377. doi: 10.1016/j.juro.2017.08.079. Epub 2017 Aug 19.
7. Wallace E, Higuchi R, Satya M, McCann L, Sin MLY, Bridge JA, Wei H, Zhang J, Wong E, Hiar A, Mach KE, Scherr D, Egerdie RB, Ohta S, Sexton WJ, Meng MV, Weizer AZ, Woods M, Jansz GK, Zadra J, Lotan Y, Goldfarb B, Liao JC. Development of a 90-Minute Integrated Noninvasive Urinary Assay for Bladder Cancer Detection. J Urol. 2017 Oct 20. pii: S0022-5347(17)77760-9. doi: 10.1016/j.juro.2017.09.141. [Epub ahead of print]
8. Kavalieris L et al. Performance Characteristics of a Multigene Urine Biomarker Test for Monitoring for Recurrent Urothelial Carcinoma in a Multicenter Study. J Urol. 2017 Jun;197(6):1419-1426. doi: 10.1016/j.juro.2016.12.010. Epub 2016 Dec 14.
9. Shah AS  et al. Rates and Risk Factors for Opioid Dependence and Overdose after Urological Surgery. J Urol. 2017 Nov;198(5):1130-1136. doi: 10.1016/j.juro.2017.05.037. Epub 2017 May 12. 


Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, | twitter: @tchandra_uromd at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA