SUO 2021

SUO 2021: Role of Focal Therapy for Localized Prostate Cancer: Point/Counterpoint Debate - Against Focal Therapy

(UroToday.com) In a plenary session at the Society of Urologic Oncology Annual Meeting focused on early prostate cancer diagnosis and treatment, Dr. Caroline Moore and Dr. Daniel Spratt provided a point/counterpoint debate on the role of focal therapy for localized prostate cancer. Following Dr. Moore’s presentation, Dr. Spratt argued against focal therapy.

SUO 2021: Role of Focal Therapy for Localized Prostate Cancer: Point/Counterpoint Debate - Focal Therapy Should Be Considered

(UroToday.com) In a plenary session at the Society of Urologic Oncology Annual Meeting focused on early prostate cancer diagnosis and treatment, Dr. Caroline Moore and Dr. Daniel Spratt provided a point/counterpoint debate on the role of focal therapy for localized prostate cancer. Beginning first, Dr. Moore argued that focal therapy should be considered.

SUO 2021: Hypofractionation in Unfavorable Risk Localized Disease: Status of the Evidence

(UroToday.com) In a plenary session at the Society of Urologic Oncology Annual Meeting focused on early prostate cancer diagnosis and treatment, Dr. Neil Desai discussed the role of hypofractionation for patients treated with radiotherapy for unfavourable risk localized prostate cancer.

SUO 2021: Expanding Active Surveillance - Considerations for Grade Group 2

(UroToday.com) In a plenary session at the Society of Urologic Oncology Annual Meeting focused on early prostate cancer diagnosis and treatment, Dr. Behfar Edhaie spoke, in place of Dr. Sigrid Carlsson, about considerations for the use of active surveillance in patients with grade group 2 prostate cancer.

SUO 2021: Adverse Prostate Cancer Pathological Variants: Considerations for Management

(UroToday.com) In a plenary session at the Society of Urologic Oncology Annual Meeting focused on early prostate cancer diagnosis and treatment, Dr. Jennifer Gordetsky discussed pathological variants of prostate cancer and their influence on treatment.

SUO 2021: Mitigating Infection Rates in Prostate Biopsy

(UroToday.com) In a plenary session of the Society of Urologic Oncology Annual Meeting focused on transperineal prostate biopsy, Dr. Edward Schaeffer began the session by discussing strategies to mitigate infections among patients undergoing prostate biopsy.

SUO 2021: Smarter Screening - Integrating Emerging Polygenic Risk Scores and PSA Screening

(UroToday.com) In a plenary session at the Society of Urologic Oncology Annual Meeting focused on early prostate cancer diagnosis and treatment, Dr. Burcu Darst discussed the role of polygenic risk scores (PRS) to improve prostate-specific antigen (PSA)-based prostate cancer screening.

SUO 2021: Should Transperineal Biopsy Be Standard of Care for Patients Undergoing Prostate Biopsy?

(UroToday.com) In a plenary session of the Society of Urologic Oncology Annual Meeting focused on transperineal prostate biopsy, Dr. Jonathan Shoag discussed whether a transperineal biopsy should become the standard of care for patients undergoing prostate biopsy.

SUO 2021: Local Regional Anesthesia Considerations for Transperineal and Transrectal Prostate Biopsy

(UroToday.com) In a plenary session of the Society of Urologic Oncology Annual Meeting focused on transperineal prostate biopsy, Dr. Timothy McClure discussed considerations regarding local and regional anesthesia for transperineal and transrectal prostate biopsy, with a focus on the anatomic and neuro-anatomy of the pelvis.

SUO 2021: Clinical Trials of Transperineal Prostate Biopsy

(UroToday.com) In a plenary session of the Society of Urologic Oncology Annual Meeting focused on transperineal prostate biopsy, Dr. Badar Munir Mian discussed current trials assessing the role of transperineal biopsy in prostate cancer.

SUO 2021: Integrating Transperineal Prostate Biopsy Into the Clinic: Logistical Considerations for Practice

(UroToday.com) In a plenary session of the Society of Urologic Oncology Annual Meeting focused on transperineal prostate biopsy, Dr. Ashley Ross discussed integrating transperineal biopsy into the clinic.

SUO 2021: Our Specialty, Our Society and Our Patients -- Moving Beyond Ambition to Organizational Competency from a US Health System Perspective

(UroToday.com) In a state of the art lecture at the Society of Urologic Oncology Annual Meeting, Dr. Tracy Morris Downs discussed how we may move beyond ambition to organizational competency from a United States Health System perspective.

SUO 2021: Improving Detection of Clinically Significant Cancer

(UroToday.com) In a plenary session of the Society of Urologic Oncology Annual Meeting focused on transperineal prostate biopsy, Dr. Arvin George discussed approaches we may consider for improving the detection of clinically significant cancer. In particular, he emphasized that this considers how transperineal biopsy may improve the yield of biopsy, particularly at the apex and anteriorly.

SUO 2021: Should Transperineal Biopsy Be Standard of Care?

(UroToday.com) In a plenary session of the Society of Urologic Oncology Annual Meeting focused on transperineal prostate biopsy, Dr. Deborah Kaye discussed whether a transperineal biopsy should become the standard of care for patients undergoing prostate biopsy.

SUO 2021: Health Information Technology to Improve Clinical Processes and Patient Care

(UroToday.com) The Society of Urologic Oncology (SUO) 2021 annual meeting in Orlando, FL hosted a special presentation by Dr. Kenneth G. Nepple, MD that addressed the importance of health information technology to improve clinical processes and patient care. Although Dr. Nepple is still a practicing urologic oncologist, he has assumed many administrative and leadership tasks within The University of Iowa Health Care System that have provided him with a unique perspective on how to address issues across these two disciplines.

The main objective of his talk was to emphasize practical advice on how one can impact their own institution through his own experiences, mainly with regards to the digitalization of care.

He began his talk by noting that although urologists have been keen to adopt new surgical technologies, we have not had the same mentality with regard to electronic health records (EHR). Urologists, and physicians alike, have adopted a “got-to” instead of a “get-to” mentality and phrases such as “Death by a Thousand Clicks” have been coined. Common issues/complaints have included:

  • Documentation requirements
  • Increased regulations
  • Compliance requirements
  • Billing/coding difficulties
  • Joint commission policies
  • Quality/safety metrics

It has been suggested that to combat physician burnout and improve patient care, we need to fix the electronic health record system. The target audience with EHR, similar to other disciplines, can be broken down into five groups: Innovators (tech enthusiasts), early adopters (visionaries), early majority (pragmatists), late majority (conservatives), laggards (skeptics).

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In Dr. Nepple’s own words, the roadmap to change includes identifying an unmet need, showing its value, and asking for support. This is how he believes he has been able to turn a 0.50 full-time equivalent (FTE) into 150% productivity. This can result in service + education + research. He went on to give credit to the importance of physician leadership within the hospital.

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He next shared a personal story from 2014, when there was significant displeasure with the state of Iowa Hospital’s EHR system at that time. With the assistance of one of his medical students, John Gravelle, they quantified the displeasure which was more pronounced in the staff physicians (compared to the resident urologists). Next, they detailed the specific issues (too many navigational options, inefficient use of the cancs, disconnected flow of clinical information, etc.) and presented it to their institution to make the recommended changes. A post-implementation survey distributed 4 months post-deployment demonstrated significant improvement in the overall satisfaction scores. Other personal lessons learned included the importance of not :”kimping on the screen”. There are recommended statistics for effective use. Importantly, adoption of software change is contingent on available hardware.

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Dr. Nepple went on to detail the considerable financial and administrative staff support that is required for information systems teams (capital budget >$61 million at Iowa Hospital, 435 full time staff members, ~20,000 computers, 6 Petabyte storage). This team also monitors provider efficiency profile by monitoring the hours during which physicians perform work (especially after workhours) and when patients access portals to check test results.

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He went on to discuss the importance of a culture of clinical documentation improvement with regards to accurate risk adjustment, quality reporting, and, significantly, accurate reimbursement. In 2013/2014, a urology pilot quality improvement project was carried out that identified suboptimal documentation of the service and inaccurate under-quantification of comorbidities. This impacted their revenue and rankings and led to frequent queries from nurses. The significance of this issue is highlighted in the radical cystectomy reimbursement procedure space, whereby accurate documentation of comorbidities can lead to a 2.95-fold increased reimbursement for the same procedure if more comorbidities are accurately documented. This, along with many other improvements, led to the Urology department in Iowa becoming a “best performer” service line.

 

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Another area of deficiency was the documentation of malnutrition in inpatients. Five percent of patients had a diagnosis of malnutrition with poor documentation and, thus, significantly lost institutional reimbursement during their stay. Via collaborative efforts with multiple hospitals, a workflow for easier documentation was developed and has been since piloted across multiple centers across the US. Each documentation of malnutrition had a reimbursement potential of $1,877-3,652. Consequently, the percent of patients in the hospital with a malnutrition diagnosis increased from 3.6% in 2012 to 18.9% in 2021. 

Another key point to consider is the importance of mobile technology and resident engagement. An example from his institution was providing the residents with iPads to assist with electronic learning. They developed an education application named iUrine (Iowa Urology Residents Innovating Education). Patient-entered questionnaires are also important to identify deficiencies, mainly done via patient administered questionnaires. In order to increase one’s efficiency of documentation in clinics and on the wards, the use of pre-populated smart phrases that contain educational material, cite the existing literature, etc. are crucial. Illustrations that help both patients and physicians are a key component that Dr. Nepple has incorporated into his documentation. 

Presented by: Kenneth G. Nepple, MD, Associate Chief Medical Information Officer, Physician Value Officer, Physician Advisor for Clinical Documentation Improvement, Associate Professor of Urology, Department of Urology, University of Iowa Health Care, Iowa City, IA 

Written by: Rashid Sayyid, MD, MSc – Urology Chief Resident, Augusta University/Medical College of Georgia, @rksayyid on Twitter during the 2021 Society of Urologic Oncology (SUO) Winter Annual Meeting, Orlando, FL, Wed, Dec 1 – Fri, Dec 3, 2021. 

 

SUO 2021: State of the Art: Molecular Classification of Upper Tract Urothelial Carcinoma

(UroToday.com) The Society of Urologic Oncology (SUO) 2021 annual meeting in Orlando, FL included an overview of molecular classification of upper tract urothelial carcinoma (UTUC), presented by Dr. Jonathan Coleman, MD, Associate Professor at the Memorial Sloan Kettering Cancer Center in New York, NY. 

SUO 2021: Integration of Somatic and Germline Next Generation Sequencing Results into Clinical Management of Patients with Advanced Prostate Cancer

(UroToday.com) The Society of Urologic Oncology (SUO) 2021 annual meeting in Orlando, FL hosted an overview of integrating somatic and germline next generation sequencing results into the clinical management of patients with advanced prostate cancer, presented by Dr. Kara N. Maxwell, MD, PhD.

SUO 2021: Does the Evidence Justify Extrapolating the Benefit of Neoadjuvant Chemotherapy from Bladder Cancer to Upper Tract Urothelial Carcinoma?

(UroToday.com) The Society of Urologic Oncology (SUO) 2021 annual meeting in Orlando, FL was host to an excellent, thought-provoking presentation by Dr. Jean Hoffman-Censits, MD, discussing whether there is evidence to justify extrapolating the benefit of neoadjuvant chemotherapy from bladder cancer to upper tract urothelial carcinoma (UTUC).

SUO 2021: Limited Versus Extended Lymph Node Dissection: Point/Counterpoint

(UroToday.com) The Society of Urologic Oncology (SUO) 2021 annual meeting in Orlando, FL hosted a debate regarding the role of pelvic lymph node dissection (PLND) in prostate cancer presented by Dr. Karim A. Touijer, MD, MPH who had the unenviable task of advocating both for and against this procedure.

SUO 2021: Emerging Biomarkers to Identify Patients with High-Risk Non-Metastatic Renal Cell Carcinoma

(UroToday.com) The Society of Urologic Oncology (SUO) 2021 annual meeting in Orlando, FL hosted an overview of emergent biomarkers to identify patients with high-risk non-metastatic renal cell carcinoma (RCC) presented by Dr. Brandon Manley, MD. Dr. Manley began his talk by discussing methylation profiles in clear cell RCC (ccRCC). Wei et al. used genome-wide CpG methylation profiling, a LASSO model to develop a five-CpG-based assay for ccRCC prognosis. The five CPG-based classifiers were validated in three independent sets from China, the United States, and the Cancer Genome Atlas data set, predicting overall survival of ccRCC patients with a HR of 2.96-4.82, p<0.001. The five-CpG-based classifier categorizes patients into high and low-risk groups and the methylation profile correlates with expression of 5 genes: PITX1, FOXE3, TWF2, EHBO1L1, and RIN1.1

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