From the Editor—April 2024: AUA Annual Meeting Recap—A Journey Through Science, Technology, and Networking

People, Places, and Things Returning from the 2024 Annual Meeting of the American Urological Association in San Antonio, TX, I am impressed with how the meeting planners have "compacted" the meeting in the past years, yet layered out so much content to let attendees still have a lot of opportunities to learn, whether they are focused on 1 subspecialty or several areas. I am thinking back to prior eras of the annual meeting when we mostly arrived on a Friday and had content until the next Thursday morning. With the new format, there are only a few nights to fit in so many networking events. But overall, a solid 3.5 days of science, technology, and networking. I will run through my meeting experience for the pictorial as an illustration of how much opportunity is possible at the annual meeting. Thursday—arrival time; yes I brought the airstream again since it is so close to home. Thursday night was a reception from the AUA office of education, combining the various committees into a single group. Congratulations to Jay Ramen, chair of the office of education, on another excellent year of educational programs for our members—Figure 1. How many education committees can you name? Here is the list: APPs, Leadership and Business Education, New Technologies and Imaging, Urologic Video Education, Core Curriculum, Medical Student Education, and Update Series. Thursday night—a good opportunity to photograph our meeting venue of downtown San Antonio and the River Walk district. Our last meeting here was in 2005. It is a nice overall venue for us, and hotel access was certainly improved. From my understanding, it will not be a regular meeting rotation, but we may be back. It is a challenging travel plan for international guests. Figures 2-4 highlight the key San Antonio views from our venue. Friday: JUOP editorial board meeting. After the JU editorial board met from 6 am to 8 am, the JUOP board had its annual in-person meeting. We reviewed journal metrics, updates from the publisher, editorial position roles, and welcomed new editors to the team who will be on our website soon: Janet Kukreja, Andrew Hahn, Grace Biggs, Alex Vanni, and Tim Clinton. Figure 5: JUOP editorial board meeting. We finished with a group strategy discussion. For the second year, our associate editor Marisa Clifton was taking on a mentee from medical school interested in urology—what a great experience for a student to follow all of Marisa's meeting events including our board meeting. Moving on to the science, the Plenary sessions were high tech as usual (Figure 6) and plenty of afternoon poster sessions to focus on specific areas (Figure 7). Finally, the Mt Sinai group put on another well-attended symposium on robotic surgery including 3D video semi-live cases—Figure 8. The day finished with the Urocare Foundation fundraiser with a "Boots and Buckles" theme—Figure 9. Saturday: The AUA Office of Education put on another series of instructional courses covering all aspects of urology. Keith Kowalczyk led another course on robotic prostatectomy techniques to preserve continence—Figure 10. Another offering from the education group was the video abstract program, with a special presentation area in the exhibit hall area near the Square. At JUOP, we had 3 highly reviewed abstracts join the pathway to publications to be a full video manuscript. Saturday night became the main time slot for various networking events. The AUA honored its new class of leadership program graduates, and many departments host alumni gatherings—Figure 11. Sunday: While there were many continued plenaries and abstract sessions, there were also unique forum sessions on prostate cancer (Figure 12) and bladder cancer that drew large attendance and plenty of time for discussions with the audience. To finish the day—finally some time to visit the exhibits and talk with industry partners—Figure 13. Figure 1.: People. The Office of Education committee members reception.Figure 2.: Places. The 2024 AUA Annual Meeting venue at the Henry Gonzalez Convention Center—with the River Walk and the Tower of the Americas in view.Figure 3.: Places. Attendees could enjoy the nearby River Walk scenes with hotels and restaurants nearby. A standard humorous comment during the boat rides during the safety briefing is that if you find yourself overboard, you simply stand up and walk to the side—its only 3 to 4 feet deep.Figure 4.: Places. The 750-foot Tower of the Americas looms over the convention center and River Walk areas. The tower was built in 1968 for the Hemisfair World's Fair.Figure 5.: People. The second JUOP editorial board meeting.Figure 6.: People. The Friday Plenary featured an excellent review of artificial intelligence led by Andrew Hung (pictured) and his panel of Geoffrey Sonn, Joseph Liao, and Prokar Dasgupta.Figure 7.: People. Daniel Barocas leads a moderated poster session.Figure 8.: Things. The Mt Sinai Innovations in Robotic Surgery featured lectures, panels, holographic presenters from remote locations, and semi-live surgery presented in 3D with glasses for all.Figure 9.: People. Friday night included the Urocare Foundation event "Boots and Buckles" to raise money for urological research. Pictured—Urocare Foundation secretary Badar Mian (left) and Journal of Urology Editor Rob Siemens (right).Figure 10.: People. Keith Kowalczyk was one of many AUA course directors for the Office of Education series—this one on anterior pelvic fascia–sparing approaches to robotic prostatectomy. This course had approximately 80 attendees in person and over 250 by virtual connection. The AUA meeting app could send audience questions from remote attendees to the faculty.Figure 11.: People. Saturday night awards for the AUA Leadership class of 2024 (11a) and many alumni gatherings such as this one for the MD Anderson alumni gathering on a rooftop bar.Figure 12.: People. At the 23rd International Prostate Forum, the panel on advanced prostate cancer presented several emerging topics, themes, and discussed audience questions.Figure 13.: Things. Hopefully most attendees had time to visit the exhibit hall which had industry partner displays, AUA central, and the Surgery Theater. An exhibiting company went the extra mile to work in a Back to the Future movie theme to their product campaign. A local San Antonio Delorean owner has outfitted the car to match the movie—and it still drives!April Article Reviews Reviews What is the latest consensus and future directions in castration-sensitive prostate cancer? Crawford et al1 organized a large, multidisciplinary consensus meeting and reported the group's results. The overall format of this narrative review/consensus statement is to outline the key tools available to optimize the diagnostic efforts and subsequent treatment planning (excluding the well-known differences between standard local treatment options). Thus, the reader can quickly review the key controversies with risk classification, molecular targeted imaging, biomarkers, biochemical recurrence, and combined local/systemic treatments of metastatic disease. A nice touch is the inclusion of the most pivotal trials underway aimed at answering specific controversies. Full disclosure—I am a co-author here, and our Journal uses proxy editors to exclude me from peer review and decisions. A companion article from Bryce et al2 continues this review effort with castration-resistant disease and dives into updates in PARP inhibitors, androgen pathway inhibitors, combinations, theranostics, variant disease, and future combination/layering of systemic therapy. Using a systematic review process, Odeh et al3 from the Netherlands updated the status of DNA methylation markers for renal cell carcinoma. They found a series of novel markers compared with prior review efforts. The updated panels may have a clearer association with overall survival or progression free survival. An interesting part of their discussion is the observation that the publication review finds more efforts in continuing to find novel biomarkers, whereas more efforts should focus on validating the ones we already have. Continuing with renal cell carcinoma prognosis, Li et al4 performed a meta-analysis of 29,366 patients with metastatic renal cell carcinoma to clarify prognostic variables for overall survival. As these variables can predict survival, they may also influence treatment choices. In addition to well-known variables, this search identified location of metastasis, previous nephrectomy status, neutrophil-lymphocyte ratio, and C-reactive protein. Retrospective Study Wang et al5 from Washington University evaluated the combination of 4K score and MRI pre-prostate biopsy. The combination was improved compared with either test alone. This was not a formal study and a good discussion of limitations by the authors. In my personal practice, I find secondary biomarkers useful for equivocal MRI results or patients being screened in older ages where you are trying not to overdetect. Clinical Trial Study Within the established trial called the North Caroline Prostate Cancer Comparative Effectiveness and Survivorship Study, Spellman et al6 prospectively studied decision regret in localized prostate cancer. The study featured follow-up through 120 months and compared different treatment modalities. It was encouraging that active surveillance had some of the lowest decision regret. More work needs to be performed to improve curative treatments. Multivariable factors of decision regret included race, marital status, treatment type, and months from treatment. Rare Conditions Schwieters and Santa-Cruz7 present an interesting case report of prostate cancer diagnosis in a patient with melanoma with suspicious FDG PET imaging—despite normal PSA and DRE. MRI was also conclusive and favored a biopsy showing high-risk disease. A comprehensive study would be valuable, but here is one example of PET imaging finding disease that is missed in standard screening detection. Video Holmium laser technology is featured by Alkassis et al8 in solving ejaculatory duct obstruction—the video speaks for itself.