Urology in the Desert 2000

76th Annual Meeting of the Western Section of the American Urological Association

MEETING REVIEW Urology in the Desert 2000 Highlights from the 76th Annual Meeting of the Western Section American Urological Association [Rev Urol. 2001;3(2):99–101] © 2001 MedReviews, LLC T he 76th Western Section American Urological Association Annual Meeting was held this year in Palm Desert, Calif., from November 5 to 9, at the Marriott Desert Springs Resort. Medical students, residents, physicians, scientists, and urologists attended to listen to entries presented by speakers from all over the United States, Canada, and Australia. In all, 250 abstracts were presented in 12 sessions, including an audiovisual session mostly devoted to laparoscopy. Cancer and cancer-related topics made up the largest body of information (45% of presentations) Reviewed by Amnon Zisman, MD, Allan J. Pantuck, MD, Stephen J. Freedland, MD, Arie S. Belldegrun, MD, FACS, University of California School of Medicine, Los Angeles, CA presented this year. The prostate was again the most represented topic at the 2000 meeting, with 50 clinical and 13 research posters (25% of posters), which were mostly devoted to oncologic topics. The clinical studies on prostate cancer (CaP) focused on topics such as strategies in transrectal prostate biopsy as well as quality of life and socioeconomic aspects of prostate cancer. A number of studies concentrated positive surgical margins, or seminal vesicle (SV) invasion among patients undergoing radical prostatectomy. Dr. Presti used a high-yield (>40%) extended systematic biopsy scheme in 982 Caucasian (C) and AA men with elevated (>4 ng/ml) prostatespecific antigen (PSA) and compared for racial differences in PSA, prostate-specific antigen density (PSAD), and TZD. As expected, these indices were different between CaP A number of studies concentrated on research into racial differences among CaP patients. on research into racial differences among CaP patients. Dr. Freedland was able to show in a multivariate analysis that African-American (AA) origin per se is not an independent predictor of non-organ-confined disease, and non-CaP patients but not between AA and C men. In a specific subgroup of AA men with normal digital rectal exams (DREs), TZD was higher than in C men. A comparison between C and Filipino military men SPRING 2001 REVIEWS IN UROLOGY 99 Urology in the Desert continued diagnosed with CaP performed by Dr. Bloom found no significant racial differences except for the fact that Filipino men presented at younger ages. Among the multiple studies on prostate biopsy, the work by Dr. Terris on spectroscopic identification of prostatic abnormalities during prostate biopsy shows special potential for a future real-time CaP homing capability. Using a real-time spectroscopic needle system, Dr. Terris and colleagues showed in vivo reduced saturation in regions of the prostate with CaP and increased saturation in regions with inflammatory infiltrates. An update, as well as data from the CaPSURE TM prostate cancer health outcomes database, was presented by the UCSF group. Currently, data for 5000 CaP patients from 33 community-based urology practices in the United States have been inserted into the database. Using the CaPSURE database, Dr. Grossfeld and coworkers showed a significant improvement in health-related quality of life in 10 patients receiving intermittent androgen deprivation while off luteinizing hormone releasing hormone (LHRH) therapy. Two thirds of the posters presented in the research forum focused on prostate cancer and dealt mainly with basic and applied aspects of apoptosis and angiogenesis and with new strategies in the treatment of CaP, including sensitization to chemotherapy or radiation and antisense therapy. The UCLA group presented a new hormone-refractory metastatic prostate cancer tumor model established in severe combined immunodeficient (SCID) mice stably transfected with green fluorescence gene for improved detection of the metastatic foci in vivo. Using this tumor model, designated CL-1, Dr. Zisman and colleagues showed that subclinical concentrations of actinomycin D can work synergistically with the TNF 100 REVIEWS IN UROLOGY SPRING 2001 related apoptosis inducing ligand (ApoIIL/TRAIL) and sensitize CL-1 cells to 90% killing mediated by this nontoxic proapoptotic agent. A number of studies looked at mechanisms of radiation resistance in prostate cancer and strategies for overcoming them. Dr. Garzotto and coworkers treated (LNCaP) prostate cancer cell line with 20 Gy of ionizing radiation and found that an apoptotic response was not generated despite a marked increase in p53 expression by the cells. They showed evidence that failure of LNCaP to express the proapoptotic protein Bax may underlie its relatively high degree of radiation resistance. Further work by Dr. Gleave’s group from Vancouver was presented; it looked at antisense oligonucleotides against testosterone-repressed prostate message-2 (TRPM-2), a cell survival gene that may also mediate resistance to radiation-induced apoptosis. Data were presented that showed increased efficacy of radiation in the advances in laparoscopy, and tumor markers to immunotherapy, new tumor vaccines, and other molecularbased therapies for metastatic disease. A number of abstracts presented new data on novel forms of minimally invasive therapies for benign prostatic hypertrophy. Dr. Brar and colleagues from Tucson found interstitial laser coagulation of the prostate to be an effective treatment, capable of inducing significant improvement in lower urinary tract symptoms, that can be performed under local anesthesia. However, although Dr. Reese from San Jose also provided evidence for excellent short-term results with this procedure, his group found a high rate of failure occurring within 1 to 2 years. Baseline criteria could not distinguish who was likely to derive long-term benefit. Dr. Kabalin presented the results of a randomized, multi-institutional study using periurethral prostatic microwave thermotherapy versus sham controls. He found statistically While the greatest emphasis was on the prostate, a number of interesting studies were also presented that looked at novel strategies for staging, surgical extirpation, and treatment of advanced RCC. PC-3 prostate tumor model after inactivation of TRPM-2 by antisense oligonucleotides. Dr. Pocsidio, from Loma Linda, California presented the results of preclinical studies using vaccinia virus v. mediated gene transfer of the wild-type p53 gene in a mouse bladder tumor cell model. These studies showed the vaccinia recombinants to be efficient vectors both in vitro and in vivo, capable of producing apoptosis in transfected cells. In the state-of-the-art lecture this year, Dr. Vaughan, president-elect of the AUA, comprehensively examined a number of changing patterns in the treatment of renal cell carcinoma (RCC), going from epidemiology, significant improvements in the AUA symptom index in the treated group, which were maintained at 1 year. Dr. Malek presented results from an ongoing study using potassium titanyl phosphate (KTP) laser vaporization of the prostate, showing it to be a technically easy, effective outpatient procedure producing relief from obstructive BPH through 2 years of follow-up. While the greatest emphasis was on the prostate, a number of interesting studies were also presented that looked at novel strategies for staging, surgical extirpation, and treatment of advanced RCC. Dr. Stewart, from Loma Linda, California presented a case report describing a new technique for Urology in the Desert achieving hemostasis during partial nephrectomy, using small intestine submucosa xenografts for suture bolsters. Possible advantages of this technique include decreased inflammation and faster tissue incorporation. Zisman and coworkers at UCLA presented a rationale for the use of an integrated staging system, incorporating the 1997 TNM staging system, Fuhrman’s grading system, and ECOG performance status into a 5-group staging system to better define the prognosis of RCC patients. Using the same dataset, Dr. Pantuck and colleagues summarized their 10-year experience with RCC patients at UCLA and concluded that T1 patients can achieve equivalent long-term survival with either partial or radical nephrectomy, whereas patients with tumors larger than T1 achieve improved survival with radical surgery. T3 patients undergoing nephrectomy have shorter survival times than those with organ-confined disease, suggesting the need for effective adjuvant therapies for high-risk patients. Dr. Pantuck’s group also showed that for patients with metastatic RCC the combination of cytoreductive nephrectomy with postoperative IL-2-based therapy results in significantly improved survival compared to that seen in patients treated with IL-2 alone. These findings were supported by results presented by Dr. Evans, from Edmonton, Alberta, who showed improved prognosis for metastatic RCC patients who were younger than 55; received treatment with interferon; and had pretreatment nephrectomy, good performance status, low serum lactic acid dehydrogenase (LDH) levels, and a small number of metastatic sites. Forty-one abstracts (16%) covered endourologic topics; urologic laparoscopy was represented in 24 of them. In these abstracts the authors shared their experience with various urologic laparoscopic procedures, such as nephrectomy for cancer and other indications, as well as laparoscopic adrenalectomy, radical prostatectomy, retroperitoneal lymph node dissection for nonseminomatous germ cell tumors, and laparoscopic live donor nephrectomy for renal transplantation. The lively discussions on the role of laparoscopy as well as the informal conversations on specific technicalities clearly indicated that laparoscopy in urology is here to stay and that urologists from various backgrounds are very interested in the field. This year, Dr. Karl-Dietrich Sievert of USCF won first place in the 34th Miley B. Wesson/Procter & Gamble essay contest for his work related to upper motor neuron spinal cord injuries and detrusor-sphincter studying the capability of vascular endothelial growth factor (VEGF) to reverse veno-occlusive erectile dysfunction. Administration of VEGF as a protein or as a gene, using adenoassociated viral VEGF gene vector, prevented veno-occlusive dysfunction in castrated rats, reversed the cavernosometric findings of leakage in animals with pre-established venous leak, and maintained the histological integrity of penile smooth muscle after castration. Two clinical studies won the 55th Joseph F. McCarthy/Circon ACMI 2000 essay contest. Dr. Santucci, who won first prize, has validated the American Association for the Surgery of Trauma (AAST) organ injury scale for the kidney using the UCSF database of over 2500 renal trauma patients. He showed that factoring the AAST organ injury scale in with two additional parameters, the presence or absence of pararenal hematoma and the need for blood transfusion, could accurately predict Laparoscopy in urology is here to stay. dyssynergia (DSD). He studied sacral root stimulation using the sinusoidal signal and specific organ frequency in 20 male dogs and was able to artificially induce physiologic-like bladder evacuation: Sphincteric fatigue was achieved by 10- to 15-s S2 prestimulation followed by S3 stimulation, which caused the detrusor pressure to rise to 29 cm H2O above the sphincteric pressure with no additional rise in the sphincteric pressure. Second place was earned this year by Dr. Rogers and colleagues, also from UCSF, for their work in the rat model 95% of cases requiring surgical kidney repair. Dr. Terris of Stanford University demonstrated the strengths and weaknesses of fluorodeoxyglucose positron emission tomography (PET) imaging in the staging of transitional cell carcinoma to win second place in the Joseph F. McCarthy/ Circon ACMI 2000 essay contest. The meeting concluded with a roundtable discussion on techniques and anecdotal issues and with a call for participation in next year’s 77th gathering, which will be held in Anchorage, Alaska. SPRING 2001 REVIEWS IN UROLOGY 101