Andrew Stephenson

Surgeon. Dad. O.G. Curing prostate bladder testis kidney cancer one patient, one trial, one study, and one trainee at a time. Pro decency. 🇨🇦🇺🇸🇺🇦

[Andrew Stephenson @RealProstateDoc]

@siadaneshmand @IUuro @nabiladra @SBoorjian @pcvblack @uroegg @drphil_urology @kellystratton @LuciaNappi4 @Testiscancer @GU_BigWhacks Excellent work. Transformative.

[Andrew Stephenson @RealProstateDoc]

@dr_coops @uroegg @KeithKow @RobertReiterMD @auvinen_anssi @MA_Preston Important point re: marker+/MRI-. If pretest probability very high, a negative test (i.e. MRI) may not alter post-test probability all that much. Still favor biopsy in high risk pts despite neg MRI - especially if one doesn’t have expert MRI reviewer.

[Andrew Stephenson @RealProstateDoc]

@ChapinMD @uroegg @KeithKow @RobertReiterMD @dr_coops @auvinen_anssi @MA_Preston Great approach / philosophy.

Off-ramps => repeat PSA, free:total, 4K, select MDX, mpMRI

I do use PCPT risk calc in almost all pts - estimate risk of important cancer. If > 10%, MRI +/- biopsy warranted.

[Andrew Stephenson @RealProstateDoc]

@dr_coops @urogeek @KeithKow @uroegg @chrisfilson_uro @mleapman @JAMANetworkOpen @AmerUrological @dartmouth Look at PROTECT and recent data from Ontario Canada => in the end, almost all GG1 get treated, sooner or later. I doubt the treatment rate among pts on AS is largely physician driven. Lots of progress to be made. @UroOncMD

[Andrew Stephenson @RealProstateDoc]

@jimhumd Single dose FQ with IM gent (or IM 3rd gen ceph). Negligible sepsis rate.

[Andrew Stephenson @RealProstateDoc]

@UroOncMD @DrAndrewLoblaw @KariTikkinen @CanUrolAssoc @JUrology @AmerUrological @UofTSurgery @UofTUrology @LoebStacy @auvinen_anssi @TurkuUroOnc @Uroweb @Phil_Violette Honestly, I am amazed survival differences were observed among a cohort of low-risk pts who were treated compared to another cohort of whom 60% received treatment (albeit delayed). Maybe GG1 is actually a cancer! Fascinating and provocative. @uroegg @dr_coops

[Andrew Stephenson @RealProstateDoc]

@AmarUKishan Equally relevant for surgical planning purposes. Perhaps this explains the conflicting data re: LND in RALRP. Important anatomical regions may be unaddressed surgically in many LN dissections. Exciting times for potential refinements in treatment.

[Andrew Stephenson @RealProstateDoc]

@UroOncMD The initial challenge was convincing patients & clinicians to buy into AS. The challenge now is to identify reliable indicators for when AS should be abandoned. Much of this is also patient-driven anxiety and fatigue. Unfortunately, these data are similar to many others.

[Andrew Stephenson @RealProstateDoc]

@BEkidneystone @MGHUrology @hollenbeck1971 @urochiefmlb @AFeldmanMD Well-deserved. Congratulations 👏🏻

[Andrew Stephenson @RealProstateDoc]

@JGrummet @uroegg @vipurology @daviesbj A reliable BCR endpoint for focal therapy is likely to be elusive => so many confounders with intact and untreated prostate.

[Andrew Stephenson @RealProstateDoc]

@daviesbj @uroegg @vipurology The value of a test is based in part on the pre-test probability. We published a paper in EurUrol showing that 0.05 is adequate for pts with pT3b, pN1, GG4-5. A more rigorous and specific definition is needed (e.g. 0.2 and rising) for non-high risk. NOTE: All open RP pts.

[Andrew Stephenson @RealProstateDoc]

@wandering_gu @smkaff @siadaneshmand @uroegg The AUA/ASCO GCT guidelines did not recognize RPLND as standard option until publication of the SEMS and German trials. Both of these P2 trials provide compelling evidence that it should be a consideration in non bulky CS II seminoma, as primary or CS I relapse. Stay tuned.

[Andrew Stephenson @RealProstateDoc]

@Testiscancer @LuciaNappi4 @siadaneshmand Agree 100%. Relapse does not equate to mortality in GCT as in other malignancies. It’s about preventing GCT deaths with the least long-term collateral damage. So many have been banging this drum for years.

[Andrew Stephenson @RealProstateDoc]

@dr_coops @UCSFCancer @uroegg @adamkibel_uro @aleberlin2 Great work!

[Andrew Stephenson @RealProstateDoc]

Saw this nice gesture on social media in light of the tragedy at Michigan State - the house united.

[Andrew Stephenson @RealProstateDoc]

@dr_coops Agreed!

[Andrew Stephenson @RealProstateDoc]

@wandering_gu At the heart of this is universal access (public option or single-payer system).

[Andrew Stephenson @RealProstateDoc]

@SFreedlandMD @DrPaulNguyen In a way, this supports stepwise sequential treatment intensification for aggressive PC.

[Andrew Stephenson @RealProstateDoc]

@wandering_gu @vidit_sharma_ @CJStimson Huge.

[Andrew Stephenson @RealProstateDoc]

@mcg_urology @mkterris @MCG_AUG Congratulations!