AUA Convention Chicago - 2003

Fish is a specialty in this city, at least concerning eating it. Several high quality restaurants exist, like Shaws, where we had great Alaskan Crab Legs yesterday night. High buildings is also a specialty in this city, and they invented the skyscraper (or so they say). The view from the John T. Hancock Building is said to be nicer than that from the Sears Tower.The clear and wide view at the Reporter's lunch was indeed fantastic. The Signature Room, by the way, is named after the rather big signature of John T. Hancock, one of the sihnees of the Declaration of Independance.
In 1871, the city got burned down. The only remaining pre-fire historic sites are the watertower and the water pumping building - nowadays smack in the middle of the city. Only years before the fire that restored the city to its founding size, a huge undertaking to cranck up the houses (it used to be a swamp here) to prevent sewer entering the houses, was finished. Chicago is now sometimes called 'the second city'. 'Not 'cause we're second to New York', according to the bus driver, 'but 'cause the city was built a second time'.

News from the AUA frontline:
A lot of information on doing biopsies with a PSA of 2.5 - 4. The number of biopsies is not under discussion: 10-12 biopsies, depending on prostate volume. Data on 36,316 patients (DP12, USA), of which 27.5% were found to be suffering from prostate cancer while having a PSA between 2.5 - 4, while 30% were found in the PSA 4 - 10 group. A PSA cutoff of 2.5 is proposed by the authors for daily practice.
Bill Catalona then presents some data that suggest that, not unexpectedly, in the PSA 2.6 - 4 group prostate cancer is often locally confined (abs 1072, USA).

Fortunately, the potential risk of overdetection was mentioned in an analysis of the ERSPC ( European Randomized Trial of Screening for Prostate Cancer) data, comprising about 40,000 men among which 1452 men with prostate cancer (DP14, Netherlands). Simulation models showed that screening by PSA will advance prostate cancer diagnosis by about 10 years. Yearly screening of the 55-67 age group instead of once every 4 years increases the detection rate and will reveal 14% extra 'relevant' tumors, while also revealing 24% 'irrelevant' tumors. It was concluded that frequent screening will detect one irrelevant cancer for every clinically relevant cancer.

Nocturia:
The nocturia panel featured Philip van Kerrebroeck and Paul Abrams (with glasses in favourite classic position). Th importance of nocturia in the evaluation of LUTS is emphasized and the difinitions are highlighted. Paul summarized the different causes. Depending on those, sometimes simple measures kan be used to treat nocturia: 'earplugs', 'tea time diuretics', and the use of desmopressin. The latter is safe below 65, but care should be taken to ensure a diuresis of at least 2000 cc's and sodium should be checked a couple of time in the elderly. Frequency/volume charts are mandatory. The urologist is to be the authority in charge of diagnosis and treatment of nocturia. The internist is the one you should sometimes refer to. 'There is a vacuum of knowledge about nocturia. The urologist should fill this vacuum'
When the average urine production is more than 90 cc's per hour, this is said to be polyuria (abs 1374, Netherlands) as they found out after analysing 1688 men in the ageof 50 - 78.

CP/CPPS:
Chronic prostatitis aka CP/CPPS panel. Curtis Nickel is back again and discusses the importance of a standardaised symptomscore. The discussion is well rehearsed and well trained, which seems to be an upsoming feature in panel discussions. In some panels, the participants even seem brain-washed, automatically and on cue spilling out the data.
Some of the panellists seems a bit on the defensive side, advising VUDO's in all voiding problems, a TRUS in all cases of painful testicles, an MRI in case of painful ejaculation, a CT in abdominal pain? Medication and other possible therapies are mentioned: NSAID's, Cox2 inhibitors, finasteride, pentosan polysulfate, painmedication, diazepam, biofeedback, neuromodulation, ..., so, nothing new.

A press conference by Tony Atala from the Children's Hospital in Boston:
Bladder replacement via in vitro recontruction. Three layers: a biopsy delivers the muscle- and epithelial cells to be used for culture, separated by a collagen matrix. In Beagles it seems to have led to a partial bladder replacement. It seems too good to be true (abs 484, USA).

The postersessie on Advanced Prostate Cancer featured a study on Zoledronic Acid for bone metastasized prostate cancer, cleverly divided into two posters (abs 1471/1473, Canada). There is a significant effect of the stuff in the prevention of skeletal related events (17 instead of 25 broken bones in 208 patients), and some, although not dramatic effect on pain. Apart from that, we like to recall Folkmans talk earlier on this AUA, who stated that there may be a possible negative effect of Zoledronic Acid on tumor angiogenesis.
Two studies dealing with immediate vs. delayed antihormonal treatment in case of positive lymph nodes in prostate cancer. Messing (abs 1480, USA) found a difference in cancer specific survival favouring immediate treatment in 98 patients after radical prostatectomy, while Schröder (abs 1487, Netherlands) distilled no statiostical difference from EORTC study 30846 in 34 patients without radical prostatectomy. Reactions from the public: 'How do I tell my patient?'. The EORTC study seems better planned and has larger numbers.

Taking pictures at the exhibition requires a presscard, a wristband and a chaperonne. The latter not in the form of a bulky male, but an angel like lady, to fend off anyone who dares complaining about it. It all seems to have to do with legal matters and lawsuits. Pfizer seems especially frightened.
Talking about lawsuits: the John K Lattimer Lecture featured Philip Howard, who estimates that 'legal matters and defensive medicine' cost us all about 100 billion dollar per year. Not only medicine seems to be a target in a system that has been designed to give the citizen the power to defend himself against the government, but is being misused on a large scale by citizens to legally attach other citizens. To avoid lawsuits for physical damage, seesaws have been banned at schools (children can fall off), while touching of children seems taboo (for sexual reasons). A petition has been signed by leaders of healthcare, and will be signed by CEO's and other leaders of industry, to be sent to the American Congress to try to change the justice system and lauch a new system for medical justice - bioth from a patient's and a doctor's view.

Some statistics: The total number of visitors is 16,927, 10,036 of them with a medical profession.

The yearly Fun Run was badly run this year, mainly due to the lesser number of participants, which were scared off by the early hour (5.30 a.m.) and the fact that the convention building is not ideally located with respect to the hotels.

Again a nice day, topped off by some rain to blow away the dust.

More tomorrow.

ENGLISH version 26 April 2003 27 April 2003 28 April 2003 29 April 2003 30 April 2003

DUTCH version 26 April 2003 27 April 2003 28 April 2003 29 April 2003 30 April 2003