AUA 2023 Annual Meeting Preview

The first American Urological Association (AUA) conference was held in 1902 and led by Ramon Guiteras, MD, the AUA’s founder and first president. Since then, the AUA Annual Meeting has been an important, if not the most important, event for all urologists in the United States.¹ This year, the conference will take place April 28-May 1 at McCormick Place in Chicago, Illinois. In this brief review, I highlight the plenary sessions that I believe will provide the most informational value.

Prostate Cancer

There are a variety of prostate cancer-related sessions of interest to all types of clinicians, including sessions on updates to guidelines, initial detection and treatment of recurrence after radiation failure, and the use of artificial intelligence (AI). Sessions focused on guideline updates are some of the most interesting every year, as they incorporate the newest publicly available data used to decide statement changes. On Day 1 of the meeting, Dr. John Wei, a professor at the University of Michigan, will discuss updates to the Early Detection of Prostate Cancer: AUA Guideline. On Day 2, Dr. Michael Cookson, a professor and chair at the University of Oklahoma, will deliver guideline updates for the management of advanced prostate cancer. Finally, on Day 3, Dr. Daniel Ari Barocas, of Vanderbilt University Medical Center, will speak about AUA guideline updates focused on the diagnosis of prostate cancer, including the use of prostate-specific antigen, biomarkers, and magnetic resonance imaging.

Artificial Intelligence

I anticipate there will be much excitement this year regarding the use of AI in urology. On Day 3 of the meeting, Dr. Mirabela Rusu, of Stanford University, will discuss the use of AI in medical imaging analysis for prostate cancer. I suspect AI will play a critical role in helping stratify prostate biopsy results because of the rising burden experienced by pathologists due to the ever-increasing number of prostate biopsies, especially as more patients follow the active surveillance management route for low-risk disease. In recent literature, Strom and colleagues demonstrated an AI model for pathologic slide analysis for prostate biopsy with excellent outcomes.² In fact, the study’s authors concluded that AI systems can be trained to “detect and grade cancer…at a ranking comparable to that of international experts in prostate pathology.” I look forward to Dr Rusu’s presentation on the advancements in this area of AI.

Another area of interest is the use of AI in bladder cancer care. During AUA 2020, Dr. Eugene Shkolyar, of Stanford Health Care, and colleagues demonstrated a novel use for AI in the automated cystoscopic detection of bladder cancer.³ At the time, on a series of 100 patients, the authors reported a per-tumor sensitivity of 90% and a per-frame sensitivity of 88% for the automated detection of bladder cancer on cystoscopy. On Day 3 of AUA 2023, Dr. Shkolyar will discuss the use of AI-augmented cystoscopy and transurethral resection of bladder tumor and will likely share more updated results regarding the work he and his colleagues are doing in this realm.

Bladder Cancer

There are many exciting sessions to discuss in the field of bladder cancer care, including bladder transplantation. On Day 3, Dr. Inderbir Gill, of the University of Southern California Institute of Urology, will discuss results from the first human bladder transplantation trial in which the authors sought to evaluate the technical success of vascularized composite bladder allograft transplantation.⁴ Additionally, there will be various oncologic sessions focused on the improvement of postradical cystectomy care. For example, on Day 3, Dr. Sima Porten, of UCSF Health, will moderate a bladder cancer forum on the best type of urinary diversion. The debate will focus on ileal conduit versus orthotopic neobladder creation. On Day 3, Dr. Matvey Tsivian, of the Mayo Clinic, will discuss considerations for the management of clinical T2-4 disease in the geriatric population. Clinicians may also be interested in attending the instructional course on the use of trimodal therapy for muscle-invasive bladder cancer on Day 2, which will be led by Dr. Adam Feldman, of Massachusetts General Hospital.

Renal Cancer

Kidney cancer is an important topic on the minds of most urologists. There will be a variety of interesting kidney cancer-related sessions covering topics from basic science to the management of advanced disease. On Day 3, Dr. Phillip Pierorazio, of Penn Presbyterian Medical Center, will lead a case-based discussion on safe utilization of active surveillance for renal masses. On Day 4, Dr. W. Marston Linehan, of the National Cancer Institute (NCI) Clinical Center, will hold an instructional course on kidney cancer and its surgical and medical management, which may be of interest to clinicians looking to review the topic as a whole and catch up on the latest literature. Finally, as renal masses are ever-more frequently detected due to increasing use of cross-sectional imaging, clinicians must be diligent about considering patient age when determining treatment modalities. On Day 3, Dr. Angela Pecoraro, of the University of Turin, will discuss the importance of frailty assessment in patients with kidney cancer and review what current guideline recommendations suggest.

Testicular Cancer

This year’s AUA Annual Meeting will also offer several sessions of interest related to testicular cancer. The NCI estimates close to 10,000 new cases of testicular cancer will be diagnosed annually.⁵ Despite being one of the rarer urologic malignancies that urologists, urologic oncologists, and medical oncologists may encounter, it’s still imperative to be aware of the major discoveries occurring in this area. Fortunate for us, the European Association of Urology and Dr. Peter Albers, of Düsseldorf University, will hold a lecture on Day 1 to address the major paradigm shifts occurring in testicular cancer surgery. On Day 2, Steven Crocker, a testicular cancer survivor, member of the Testicular Cancer Awareness Foundation board of directors, and host of the Dumbest in the Room podcast, will discuss the importance of spreading awareness of testicular cancer through podcasting and offer clinicians the opportunity to appreciate a patient’s perspective.

The plethora of keynote presentations, workshops, and seminars included in the 2023 AUA Annual Meeting agenda guarantee clinicians will have the chance to learn and stay up to date on the latest advancements, research, and techniques in urology and urologic oncology. This event is also a unique opportunity to network, exchange ideas, and collaborate on future research projects, which will hopefully translate into future improvements in patient care.

Akhil Abraham Saji, MD, is a urology resident at New York Medical College / Westchester Medical Center. His interests include urology education and machine learning applications in urologic care. He is a founding and current member of the EMPIRE Urology New York AUA section team.

References:

1. Crane GM, Bloom DA. Ramon Guiteras: founder of the American Urological Association, surgeon, sportsman and statesman. J Urol. 2010;184(2):447-452. doi:10.1016/j.juro.2010.03.146
2. Ström P, Kartasalo K, Olsson H, et al. Artificial intelligence for diagnosis and grading of prostate cancer in biopsies: a population-based, diagnostic study. Lancet Oncol. 2020;21(2):222-232. doi:10.1016/S1470-2045(19)30738-7
3. Shkolyar E, Jia X, Xing L, Liao J. Automated cystoscopic detection of bladder cancer using deep-learning. J Urol. 2019;201(Supplement 4). doi:10.1097/01.JU.0000557512.76700.42
4. Clinical Trials and Studies. Keck Medicine of USC. Accessed March 19, 2023. https://clinicaltrials.keckmedicine.org/clinicaltrials/1606?locale=en
5. Cancer Stat Facts: Testicular Cancer. National Cancer Institute Surveillance, Epidemiology, and End Results Program. Accessed March 19, 2023. https://seer.cancer.gov/statfacts/html/testis.html