Literature reviews
News and Views From the Literature
Social Media #Urology Is Trending in Social Media Christopher E. Bayne, MD,1 Declan G. Murphy, MB, BCH, BaO, FRACS, FRCS Urol,2 Stacy Loeb, MD, MSc3 1 Department of Urology, The George Washington University, Washington, DC; 2Division of Cancer Surgery, The Peter MacCallum Cancer Centre, Melbourne, Australia; 3Department of Urology and Population Health, New York University and the Manhattan Veterans Affairs Medical Center, New York, NY [ Rev Urol. 2014;16(3):152-154 doi: 10.3909/riu0624a]
© 2014 MedReviews®, LLC
S
ocial media refers to Web-based applications through which users create and exchange usergenerated content. Most social media networks are available free of charge to everyone who creates an account. Content is generated and shared in real time with users interacting through computers and mobile devices. These qualities make social media of unique utility to medicine: rapid exchange of ideas across the globe in one minute can impact patient care the next. Academic medicine is showing increased adoption of social media. Major medical journals (eg, British Medical Journal, The Lancet, New England Journal
of Medicine, and the Journal of the American Medical Association) all have a presence on Facebook and Twitter. The peer-reviewed biographic database Scopus prominently displays social media impact in the sidebar of every article and abstract page.1 Urologists in particular have been quick to adopt social media for academic purposes. Matta and colleagues2 reported the dramatic increase in Twitter use at the American Urological Association (AUA) and Canadian Urological Association annual meetings. A combined 29 urologists generated 159 tweets at the 2012 meetings, compared with 268 urologists generating 2765 tweets in 2013. Several urology journals such as European Urology and the BJU International have embraced social media by creating Associate Editor roles for social media and digital media, respectively, and have actively encouraged the growth of social media among their readership. Two recent publications underscore the increasing use of social media in urology.
Use of Social Media in Urology: Data From the American Urological Association Loeb S, Bayne CE, Frey C, et al. BJU Int. 2014;113:993-998.
To better understand the utilization of social media by its members, the AUA emailed a 34-question survey to
152 • Vol. 16 No. 3 • 2014 • Reviews in Urology
4004170006_RIU0624.indd 152
24/09/14 10:08 AM
Social Media a random sample of 2000 attending urologists and 2047 resident/fellow members in December 2012. Of the 382 (9.4%) surveys that were completed, 245 (64%) were attending urologists. The majority of members (74%) reported having at least one social media account. Level of training (86% residents/fellows vs 66% for attending physicians) and age (83% of those under 40 years vs 56% over 40 years) were associated with the likelihood of having a social media account. The most commonly used social media accounts were Facebook (93%), LinkedIn (46%), and Twitter (36%). Members used social media for personal reasons 70% of the time. Only 16% used some social media accounts for personal use and others for business, and even fewer used the same accounts for personal and business (8%) or just business alone (4%). Members reported privacy on social media as a strong priority. Most residents (89%) and attending physicians (52%) have changed their default privacy settings, most commonly to prevent the public and patients from accessing postings and photos. However, the minority of respondents had actually been contacted by a patient on social media (39% of attending physicians vs 10% of residents/fellows). To complement the AUA survey as it related to present day social medial trends, the authors used the Symplur Web site (Symplur LLC; www.symplur.com) to examine Twitter usage during the 2013 AUA annual meeting. Specifically, Symplur analyzed the amount of Twitter traffic using the indexing hashtag #AUA13. During the 30 days before and after the meeting, a total of 644 unique contributors generated 5058 Tweets for a total of 9,163,185 impressions (sum of all tweets by participants multiplied by number of followers per participant). For comparison, the authors also examined Symplur analytics using the #EAU13 hashtag for the European Association of Urology (EAU) annual meeting held approximately 2 months earlier in March 2013. During the 60-day period around that meeting, there were a total of 1819 tweets from 246 contributors for 1,686,351 impressions. Limitations of this study include the low response rate to the survey and the use of Symplur analytics, which may underestimate the amount of Twitter participation in meetings because it only captures active use with the designated hashtag. Nevertheless, this study still represents the largest collection of surveyed data on social media use among urologists to date. The examination of Twitter traffic using the meeting hashtags #AUA13 and #EAU13 confirm the increasing utilization of social media among urologists and will provide a useful benchmark for future research on the topic.
International Urology Journal Club via Twitter: 12-Month Experience Thangasamy IA, Leveridge M, Davies BJ, et al. Eur Urol. 2014;66:112-117
In this novel publication, the authors describe the initial experience with an international urology journal club performed monthly on Twitter. The discussion occurs via tweets of 140 or fewer characters and is indexed using the hashtag #urojc. Each month, the journal club features an article from a major peer-reviewed journal. Anyone with an Internet connection can read the #urojc discussion, but participation requires a free Twitter account. During the first 12 months of the international urology journal club, 189 unique participants from 19 countries and 6 continents contributed to the discussion. The mean number of new participants each month was 14. Overall, participants contributed a mean of 195 tweets generating a mean 130,832 impressions each month. The best tweet each month was awarded a prize. The monthly #urojc articles heavily favored urologic oncology (seven prostate cancer articles, two bladder cancer articles, and one renal cancer article). Additionally, 1 month featured a urolithiasis article, and another month featured an article on live case demonstrations. Each month, article authors and/or key thought leaders joined the #urojc chat. The international urology journal club is gaining and sustaining active participation in a global capacity not possible in an offline setting. At the time of writing, the international urology journal club’s Twitter account (@iurojc) has over 1600 followers. Moreover, February’s #urojc discussion on complications after primary tumor treatment of prostate cancer was recently summarized in Lancet Oncology.3 Indeed, the international urology journal club has pioneered a new approach to journal clubs that is now being replicated in other specialties. In summary, social media provides a new way for urologists to engage in real-time discussion and disseminate knowledge. Social media use has been exponentially increasing at urological meetings. Twitter in particular is a unique platform for engagement, and the international urology journal club has successfully met every month with participation from attending and trainee urologists around the globe. References 1. 2.
Altmetric for Scopus. Altmetric Web site. http://support.altmetric.com/knowledgebase/ articles/83246-altmetric-for-scopus. Accessed April 6, 2014. Matta R, Doiron C, Leveridge MJ. The dramatic rise of social media in urology: trends in twitter use at the American and Canadian Urological Association Annual Meetings in 2012 and 2013. J Urol. 2014;192:494-498.
Vol. 16 No. 3 • 2014 • Reviews in Urology • 153
4004170006_RIU0624.indd 153
25/09/14 12:27 PM
Social Media continued 3.
Linton KD, Woo HH. Twitter International Urology Journal Club. Complications of prostate cancer treatment. Lancet Oncol. 2014;15:e150-e151.
Prostate Cancer Prostate-specific Antigen Velocity Risk Count to Discern Significant From Indolent Prostate Cancer Dara Lundon, MD,1 Stacy Loeb, MD, MSc2 Department of Urology, New York University, New York; Department of Urology and Population Health, New York University and the Manhattan Veterans Affairs Medical Center, New York, NY [ Rev Urol. 2014;16(3):154-156 doi: 10.3909/riu0624b] 1 2
© 2014 MedReviews®, LLC
P
rostate-specific antigen (PSA) velocity (PSAV) is the calculation of changes in PSA level over time, and was initially suggested more than a decade ago as a means to distinguish benign prostate enlargement from prostate cancer.1 Since that time, conflicting data on the value of PSA kinetics have been reported. D’Amico and colleagues showed that PSAV predicts the risk of prostate cancer-specific mortality after treatment,2 and the Baltimore Longitudinal Study of Aging (BLSA) demonstrated that a PSAV . 0.35 ng/mL/y more than 10 to 15 years prior to diagnosis predicts the future risk of life-threatening prostate cancer.3 However, other studies have questioned the utility of PSAV in clinical practice.4 For example, Wolters and colleagues5 reported that PSAV was significantly associated with significant prostate cancer on univariate analysis but was not an independent predictor in the multivariable model.5 The clinical utility of PSA kinetics is an extremely important issue for many reasons. First, there is ongoing controversy regarding the over-diagnosis of indolent prostate cancer. Thus, there is a need for screening modalities with greater specificity for clinically significant disease. In addition, many active surveillance programs use PSA kinetics as a trigger for intervention, particularly because noninvasive markers serve as an attractive alternative to repeated prostate biopsies.6,7 To overcome concerns regarding variability in PSA measurements, Carter and colleagues8 proposed a novel mechanism of calculation called PSAV risk count; serial PSA velocities are calculated, and the number of times that they exceed a threshold of 0.4 ng/mL/y are counted to tabulate a score. For
example, a PSAV risk count of 2 means that the PSAV exceeded 0.4 ng/mL/y twice in a row; a PSAV risk count of 1 occurs when the PSAV exceeds 0.4 ng/mL/y only once, and the risk count is 0 when none of the PSAVs exceed the 0.4 ng/mL/y threshold value. Using data from the BLSA, Carter and colleagues demonstrated that the PSAV risk count provided additional information regarding the presence of life-threatening prostate cancer compared with a single determination of either PSA or PSAV. This review describes two recent studies on PSAV risk count.
Prostate Specific Antigen Velocity (PSAV) Risk Count Improves the Specificity of Screening for Clinically Significant Prostate Cancer Loeb S, Metter E, Kan D, et al. BJU Int. 2012;109;508-514.
The purpose of this study was to determine if PSAV risk count could improve the specificity of PSA screening for prostate cancer and high-grade disease. They used data from a large US prostate cancer screening study, in which PSA and digital rectal examination (DRE) were performed at 6- to 12-month intervals.9 Prostate biopsy was recommended for PSA levels . 4 ng/mL (before 1995) or . 2.5 ng/mL (after 1995), and/or suspicious findings on DRE. Toward this end, 18,214 out of 35,536 men who participated in the prostate cancer screening study had sufficient PSA data as to allow calculation of PSAV risk count. In this screened population, the authors analyzed whether PSA velocity risk count could improve the specificity of PSA screening for overall and highgrade prostate cancer. Specifically, the study examined whether PSAV risk count significantly improved the discrimination of biopsy outcome compared with age and PSA alone. Multivariable models and net reclassification analysis were also reported. In the entire study population, a PSAV risk count of 2 was associated with 40% sensitivity, 96% specificity, 40% positive predictive value, and 96% negative predictive value for prostate cancer. On multivariate analysis with age and PSA, a PSAV risk count of 2 was associated with an 8.2-fold increased risk of prostate cancer. To predict any prostate cancer diagnosis, the area under the curve (AUC) for a base model including PSA and age was 0.89, which improved significantly with the addition of PSAV risk count (AUC 0.90; P 5 .026). To avoid misclassification of participants who did not undergo a prostate biopsy, and to specifically evaluate the relationship of PSAV risk count to tumor features, subset analysis was performed in 1524 men undergoing initial
154 • Vol. 16 No. 3 • 2014 • Reviews in Urology
4004170006_RIU0624.indd 154
24/09/14 10:08 AM
News and Views From the Literature
Social Media #Urology Is Trending in Social Media Christopher E. Bayne, MD,1 Declan G. Murphy, MB, BCH, BaO, FRACS, FRCS Urol,2 Stacy Loeb, MD, MSc3 1 Department of Urology, The George Washington University, Washington, DC; 2Division of Cancer Surgery, The Peter MacCallum Cancer Centre, Melbourne, Australia; 3Department of Urology and Population Health, New York University and the Manhattan Veterans Affairs Medical Center, New York, NY [ Rev Urol. 2014;16(3):152-154 doi: 10.3909/riu0624a]
© 2014 MedReviews®, LLC
S
ocial media refers to Web-based applications through which users create and exchange usergenerated content. Most social media networks are available free of charge to everyone who creates an account. Content is generated and shared in real time with users interacting through computers and mobile devices. These qualities make social media of unique utility to medicine: rapid exchange of ideas across the globe in one minute can impact patient care the next. Academic medicine is showing increased adoption of social media. Major medical journals (eg, British Medical Journal, The Lancet, New England Journal
of Medicine, and the Journal of the American Medical Association) all have a presence on Facebook and Twitter. The peer-reviewed biographic database Scopus prominently displays social media impact in the sidebar of every article and abstract page.1 Urologists in particular have been quick to adopt social media for academic purposes. Matta and colleagues2 reported the dramatic increase in Twitter use at the American Urological Association (AUA) and Canadian Urological Association annual meetings. A combined 29 urologists generated 159 tweets at the 2012 meetings, compared with 268 urologists generating 2765 tweets in 2013. Several urology journals such as European Urology and the BJU International have embraced social media by creating Associate Editor roles for social media and digital media, respectively, and have actively encouraged the growth of social media among their readership. Two recent publications underscore the increasing use of social media in urology.
Use of Social Media in Urology: Data From the American Urological Association Loeb S, Bayne CE, Frey C, et al. BJU Int. 2014;113:993-998.
To better understand the utilization of social media by its members, the AUA emailed a 34-question survey to
152 • Vol. 16 No. 3 • 2014 • Reviews in Urology
4004170006_RIU0624.indd 152
24/09/14 10:08 AM
Social Media a random sample of 2000 attending urologists and 2047 resident/fellow members in December 2012. Of the 382 (9.4%) surveys that were completed, 245 (64%) were attending urologists. The majority of members (74%) reported having at least one social media account. Level of training (86% residents/fellows vs 66% for attending physicians) and age (83% of those under 40 years vs 56% over 40 years) were associated with the likelihood of having a social media account. The most commonly used social media accounts were Facebook (93%), LinkedIn (46%), and Twitter (36%). Members used social media for personal reasons 70% of the time. Only 16% used some social media accounts for personal use and others for business, and even fewer used the same accounts for personal and business (8%) or just business alone (4%). Members reported privacy on social media as a strong priority. Most residents (89%) and attending physicians (52%) have changed their default privacy settings, most commonly to prevent the public and patients from accessing postings and photos. However, the minority of respondents had actually been contacted by a patient on social media (39% of attending physicians vs 10% of residents/fellows). To complement the AUA survey as it related to present day social medial trends, the authors used the Symplur Web site (Symplur LLC; www.symplur.com) to examine Twitter usage during the 2013 AUA annual meeting. Specifically, Symplur analyzed the amount of Twitter traffic using the indexing hashtag #AUA13. During the 30 days before and after the meeting, a total of 644 unique contributors generated 5058 Tweets for a total of 9,163,185 impressions (sum of all tweets by participants multiplied by number of followers per participant). For comparison, the authors also examined Symplur analytics using the #EAU13 hashtag for the European Association of Urology (EAU) annual meeting held approximately 2 months earlier in March 2013. During the 60-day period around that meeting, there were a total of 1819 tweets from 246 contributors for 1,686,351 impressions. Limitations of this study include the low response rate to the survey and the use of Symplur analytics, which may underestimate the amount of Twitter participation in meetings because it only captures active use with the designated hashtag. Nevertheless, this study still represents the largest collection of surveyed data on social media use among urologists to date. The examination of Twitter traffic using the meeting hashtags #AUA13 and #EAU13 confirm the increasing utilization of social media among urologists and will provide a useful benchmark for future research on the topic.
International Urology Journal Club via Twitter: 12-Month Experience Thangasamy IA, Leveridge M, Davies BJ, et al. Eur Urol. 2014;66:112-117
In this novel publication, the authors describe the initial experience with an international urology journal club performed monthly on Twitter. The discussion occurs via tweets of 140 or fewer characters and is indexed using the hashtag #urojc. Each month, the journal club features an article from a major peer-reviewed journal. Anyone with an Internet connection can read the #urojc discussion, but participation requires a free Twitter account. During the first 12 months of the international urology journal club, 189 unique participants from 19 countries and 6 continents contributed to the discussion. The mean number of new participants each month was 14. Overall, participants contributed a mean of 195 tweets generating a mean 130,832 impressions each month. The best tweet each month was awarded a prize. The monthly #urojc articles heavily favored urologic oncology (seven prostate cancer articles, two bladder cancer articles, and one renal cancer article). Additionally, 1 month featured a urolithiasis article, and another month featured an article on live case demonstrations. Each month, article authors and/or key thought leaders joined the #urojc chat. The international urology journal club is gaining and sustaining active participation in a global capacity not possible in an offline setting. At the time of writing, the international urology journal club’s Twitter account (@iurojc) has over 1600 followers. Moreover, February’s #urojc discussion on complications after primary tumor treatment of prostate cancer was recently summarized in Lancet Oncology.3 Indeed, the international urology journal club has pioneered a new approach to journal clubs that is now being replicated in other specialties. In summary, social media provides a new way for urologists to engage in real-time discussion and disseminate knowledge. Social media use has been exponentially increasing at urological meetings. Twitter in particular is a unique platform for engagement, and the international urology journal club has successfully met every month with participation from attending and trainee urologists around the globe. References 1. 2.
Altmetric for Scopus. Altmetric Web site. http://support.altmetric.com/knowledgebase/ articles/83246-altmetric-for-scopus. Accessed April 6, 2014. Matta R, Doiron C, Leveridge MJ. The dramatic rise of social media in urology: trends in twitter use at the American and Canadian Urological Association Annual Meetings in 2012 and 2013. J Urol. 2014;192:494-498.
Vol. 16 No. 3 • 2014 • Reviews in Urology • 153
4004170006_RIU0624.indd 153
25/09/14 12:27 PM
Social Media continued 3.
Linton KD, Woo HH. Twitter International Urology Journal Club. Complications of prostate cancer treatment. Lancet Oncol. 2014;15:e150-e151.
Prostate Cancer Prostate-specific Antigen Velocity Risk Count to Discern Significant From Indolent Prostate Cancer Dara Lundon, MD,1 Stacy Loeb, MD, MSc2 Department of Urology, New York University, New York; Department of Urology and Population Health, New York University and the Manhattan Veterans Affairs Medical Center, New York, NY [ Rev Urol. 2014;16(3):154-156 doi: 10.3909/riu0624b] 1 2
© 2014 MedReviews®, LLC
P
rostate-specific antigen (PSA) velocity (PSAV) is the calculation of changes in PSA level over time, and was initially suggested more than a decade ago as a means to distinguish benign prostate enlargement from prostate cancer.1 Since that time, conflicting data on the value of PSA kinetics have been reported. D’Amico and colleagues showed that PSAV predicts the risk of prostate cancer-specific mortality after treatment,2 and the Baltimore Longitudinal Study of Aging (BLSA) demonstrated that a PSAV . 0.35 ng/mL/y more than 10 to 15 years prior to diagnosis predicts the future risk of life-threatening prostate cancer.3 However, other studies have questioned the utility of PSAV in clinical practice.4 For example, Wolters and colleagues5 reported that PSAV was significantly associated with significant prostate cancer on univariate analysis but was not an independent predictor in the multivariable model.5 The clinical utility of PSA kinetics is an extremely important issue for many reasons. First, there is ongoing controversy regarding the over-diagnosis of indolent prostate cancer. Thus, there is a need for screening modalities with greater specificity for clinically significant disease. In addition, many active surveillance programs use PSA kinetics as a trigger for intervention, particularly because noninvasive markers serve as an attractive alternative to repeated prostate biopsies.6,7 To overcome concerns regarding variability in PSA measurements, Carter and colleagues8 proposed a novel mechanism of calculation called PSAV risk count; serial PSA velocities are calculated, and the number of times that they exceed a threshold of 0.4 ng/mL/y are counted to tabulate a score. For
example, a PSAV risk count of 2 means that the PSAV exceeded 0.4 ng/mL/y twice in a row; a PSAV risk count of 1 occurs when the PSAV exceeds 0.4 ng/mL/y only once, and the risk count is 0 when none of the PSAVs exceed the 0.4 ng/mL/y threshold value. Using data from the BLSA, Carter and colleagues demonstrated that the PSAV risk count provided additional information regarding the presence of life-threatening prostate cancer compared with a single determination of either PSA or PSAV. This review describes two recent studies on PSAV risk count.
Prostate Specific Antigen Velocity (PSAV) Risk Count Improves the Specificity of Screening for Clinically Significant Prostate Cancer Loeb S, Metter E, Kan D, et al. BJU Int. 2012;109;508-514.
The purpose of this study was to determine if PSAV risk count could improve the specificity of PSA screening for prostate cancer and high-grade disease. They used data from a large US prostate cancer screening study, in which PSA and digital rectal examination (DRE) were performed at 6- to 12-month intervals.9 Prostate biopsy was recommended for PSA levels . 4 ng/mL (before 1995) or . 2.5 ng/mL (after 1995), and/or suspicious findings on DRE. Toward this end, 18,214 out of 35,536 men who participated in the prostate cancer screening study had sufficient PSA data as to allow calculation of PSAV risk count. In this screened population, the authors analyzed whether PSA velocity risk count could improve the specificity of PSA screening for overall and highgrade prostate cancer. Specifically, the study examined whether PSAV risk count significantly improved the discrimination of biopsy outcome compared with age and PSA alone. Multivariable models and net reclassification analysis were also reported. In the entire study population, a PSAV risk count of 2 was associated with 40% sensitivity, 96% specificity, 40% positive predictive value, and 96% negative predictive value for prostate cancer. On multivariate analysis with age and PSA, a PSAV risk count of 2 was associated with an 8.2-fold increased risk of prostate cancer. To predict any prostate cancer diagnosis, the area under the curve (AUC) for a base model including PSA and age was 0.89, which improved significantly with the addition of PSAV risk count (AUC 0.90; P 5 .026). To avoid misclassification of participants who did not undergo a prostate biopsy, and to specifically evaluate the relationship of PSAV risk count to tumor features, subset analysis was performed in 1524 men undergoing initial
154 • Vol. 16 No. 3 • 2014 • Reviews in Urology
4004170006_RIU0624.indd 154
24/09/14 10:08 AM
