AUA Launches First Online Education Course for Urologic Researchers

The AUA Office of Research is excited to introduce the "Writing a Successful Career Development Award Application" course. This is the AUA's first online education course designed specifically for urologic researchers. Now available on AUA University, this course was written by NIH-funded urology researchers and will help prepare early-career investigators to write competitive grant applications. While this course focuses mainly on preparing an NIH Career Development Award (K-Award), the tips are applicable to most career development-type award mechanisms.

The "Writing a Successful Career Development Award Application" course consists of four different modules totaling over two hours of instructional material and activities. The Key Elements for Career Development Success module describes the NIH Career Development Award mechanism, outlines how this award can help build your desired research career and identifies important elements of Career Development Award success. In the second module, titled Keys to an Outstanding Career Development Plan, participants will learn how to formulate their own Career Development Plan. Topics in this module include selecting qualified mentors, identifying the strengths of your research environment and preparing a list of important career development activities in the plan. The third module, titled Writing the Research Plan, provides helpful guidance for writing the Research Plan along with an effective research strategy. The final module, titled Un-Funded to Funded: A 12 Step Program,  will enable participants to strategically modify an unfunded application based on reviewer feedback, effectively communicate with Program Officers, identify and correct common grantsmanship errors and create a positive impression on the reviewers.

The course is directed by Dale E. Bjorling, DMV, MS, who is the co-director of the University of Wisconsin-Madison George M. O'Brien Center in Benign Urologic Research and Director of the Biomedical Core of the Center. He is also Professor of Surgical Sciences and Urology, and Associate Dean of Research of the School of Veterinary Medicine. As the director of two NIH-funded training programs, Dr. Bjorling's laboratory has a long-standing interest in the investigation of mechanisms underlying bladder pain and inflammation. Additional faculty for the course include Linda A. Baker, MD, Douglas Strand, PhD, and Chad M. Vezina, PhD.

This course is part of a larger research education curriculum titled "A Toolkit for Urology Researchers." The next online course in this series, titled "Building Your Successful Urologic Research Program," is directed by Dolores J. Lamb, PhD, HCLD (ABB), and is scheduled to launch in spring 2019. Additionally, the AUA Office of Research is developing a second curriculum that will debut with a course titled "Introduction to Big Data and Omics Analysis in Urology."  This course is directed by Rosalyn M. Adam, PhD, and is scheduled to launch early 2019.

Inaugural Physician Scientist Residency Training Awardee Announced

The Urology Care Foundation, the world's leading nonprofit urological health foundation and the official foundation of the American Urological Association (AUA), is pleased to announce the selection of Joel Berends as the inaugural recipient of its new Physician Scientist Residency Training Award. This award supports an intensive, three-year research training program embedded within urology residency. The program is designed to help grow the population of surgeon-scientists who can effectively lead robust research programs, successfully compete for independent research funding and more effectively engage with basic scientists. Mr. Berends will begin residency training at the University of Michigan in July 2019.

Launched in 2017, the Physician Scientist Residency Training Award was first competed among academic institutions to select urology residency programs that could provide the necessary training and support for this innovative program. Following a competitive peer-review process and subsequent review and approval by the Accreditation Council for Graduate Medical Education, four institutions were approved as potential program sites. The second phase involved opening the competition to senior medical students who applied and competed for the inaugural award. Once selected, the recipient was presented with the opportunity to choose among these outstanding institutions for the eight-year urology residency training program.

Mr. Berends, who will graduate medical school in May 2019 from the University of Texas Health Science Center at San Antonio and begin urology residency in July, will undergo three years of research training with accomplished University of Michigan faculty after completing the initial two years of clinical training. His research training program will include coursework and seminars, rotations in a diversity of research laboratories and a two-year peer-reviewed research project. The full residency program will conclude after the final three years of clinical training.

"We are thrilled to have selected Mr. Berends as our inaugural Physician Scientist Residency Training Award recipient," said Aria F. Olumi, MD, Chief of Urology at the Beth Israel Deaconess Medical Center in Boston, Massachusetts, Professor of Surgery at Harvard Medical School and Chair of the AUA's Research Council. "He is the ideal candidate for this award and we are delighted with his selection of the University of Michigan. This new research training program further supports our ability to address the growing shortage of urology surgeon-scientists while also having a significant impact on both urology research and our patients."

The Physician Scientist Residency Training Award is the newest addition to the Urology Care Foundation's portfolio of mentored research training grants and was made possible thanks to an endowed partnership with Dornier MedTech.

Assessing Overtreatment of Urologic Cancer in Patients with Limited Life Expectancy

Timothy Daskivich, MD, MSHPM is an assistant professor of urology and Director of Health Services Research for the Department of Surgery at Cedars-Sinai Medical Center. His lab uses health services and epidemiology techniques to study overtreatment of indolent genitourinary malignancies in patients with limited life expectancy. He was recently awarded a K08 by the National Cancer Institute, mentored by Drs. Stephen Freedland and Brennan Spiegel, to develop a patient-centered approach to addressing this issue. He also received a 2018 Urology Care Foundation Rising Stars in Urology Research Award for this work.

Since starting this research during his urology residency after recognizing the challenges in treating this highly vulnerable population and the need to improve their clinical care, Dr. Daskivich has published a number of articles showing that patients with limited life expectancy—especially those with poor health status—are frequently over treated for indolent prostate and kidney cancers. Since these cancers are slow growing, patients with limited life expectancy are unlikely to benefit from aggressive treatment (e.g., surgery, radiation or ablative therapies) and are at increased risk of developing treatment-related morbidity. Because of this, guidelines uniformly recommend against such treatment for patients with limited life expectancy, but unfortunately these patients often still opt for aggressive treatment, even in the active surveillance era. This may be due to the lack of widely recognized tools to estimate life expectancy, inadequate understanding of the relative risks of cancer versus other-cause death, or inadequacy in communication of life expectancy information.

To address these issues, Dr. Daskivich’s lab has conducted studies over the last several years to describe the competing risks of cancer and other-cause deaths in patients with various age and comorbidity characteristics, and to show that aggressive therapies are less effective in patients with limited life expectancy. He delineated the competing risks of death in men with newly diagnosed prostate cancers in the VA, SEER-Medicare and PCOS populations, showing that the likelihood of dying of cancer in men with low- and intermediate-risk cancers for those over 70 with modest comorbidity burdens (or over 65 with heavy comorbid disease burdens) is exceedingly low compared with the risk of dying of other causes. Furthermore, he showed that the survival benefit of definitive local therapy for these cancers diminishes with worsening health status, becoming negligible for those over 65 years with three major comorbidities. Dr. Daskivich has even created a life expectancy prediction tool, the Prostate Cancer Comorbidity Index (PCCI), to help clinicians better implement life expectancy guidelines in practice.

With his recently funded K award, Dr. Daskivich seeks to create and test a patient-centered approach to inclusion of life expectancy into cancer treatment discussions. This project aims to elicit the perspective of the patient in understanding how best to deliver life expectancy information, then test how an optimized communication approach affects decision making. Since previous work has shown that merely providing life expectancy estimates to patients is insufficient in reducing overtreatment, Dr. Daskivich believes that this patient-centered communication approach will be critical to solving this issue. Ultimately, Dr. Daskivich hopes that his work will help empower patients with limited life expectancy to improve decision making regarding their cancer care and thereby optimize the quality of their remaining years.

The Role of NELL1 in Peyronie’s and Dupuytren’s Diseases

Alexander W. Pastuszak, MD, PhD is an assistant professor of surgery at the University of Utah School of Medicine and holds both a Career Development Award from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and a Urology Care Foundation Rising Stars in Urology Research Award. Dr. Pastuszak studies the genetic and molecular mechanisms of Peyronie’s disease and other superficial fibrosing disorders. Peyronie’s disease results in abnormal scar formation on the penis, causing penile pain, curvature and deformity, often leading to difficulties with intimacy and psychological issues such as depression and relationship issues. While there are a number of treatments for Peyronie’s disease, these often treat just the symptoms of the disease rather than the cause. In fact, the exact causes of Peyronie’s disease are not currently known. Furthermore,  Peyronie’s disease is heritable in a subset of patients, being transmitted in autosomal dominant fashion with a male predisposition.

Dr. Pastuszak and his team are working to understand the spectrum of genetic influences that impact patients with Peyronie’s disease. By genetically screening men with both Peyronie’s disease as well as Dupuytren’s disease, another superficial fibrosing disorder, Dr. Pastuszak’s lab has identified numerous candidate genes that may play a role in the pathogenesis of these conditions. NELL1 is a secreted growth factor that is involved in signaling through the BMP and TGFß1 pathways, which are important in inflammation and fibrosis. By better understanding how NELL1 impacts inflammation and fibrosis, this work will lay the foundation for a more complete understanding of the molecular pathogenic mechanisms of Peyronie’s disease, and will facilitate development of targeted, highly effective therapies that can treat Peyronie’s disease as well as other conditions involving inflammation and fibrosis. Outside of his basic laboratory work, Dr. Pastuszak’s clinical research examines the relationship between Peyronie’s disease and other genetically influenced conditions, including malignancy. His research has also led to the identification of a number of associations that may ultimately help us better understand the pathogenesis of Peyronie’s disease.

Before Dr. Pastuszak began his current work, he was awarded a Urology Care Foundation Russell Scott, Jr., MD Residency Research Award in 2011, as well as a Research Scholar Award in 2016. He credits this support for giving him the opportunity to focus on his research foundations and on continuing his basic science investigations. He also recognizes the value of the mentorship that is a cornerstone of Urology Care Foundation-funded research, and notes that he has been extremely fortunate to have developed strong relationships with mentors at every stage of his career. Given the growing challenges of being a successful surgeon-scientist in today’s healthcare environment, effective mentorship is essential in driving progress and working through barriers.

NCI Enhances its Support for Early Investigators and Trainees

The National Cancer Institute (NCI) is a critically important source of support for urologic oncology research. The NCI has recognized the growing challenges for early-career investigators and plans to sustain careers in cancer research through modifications to its grant mechanisms. The AUA consulted with Jonathan Wiest, PhD, NCI Director for Training and Education, to learn about recent changes impacting the young urologic oncology workforce.

In 2018 the NCI began offering the Method to Extend Research in Time (MERIT) (R37) award. This award is designed for a longer funding period, thereby reducing the frequency of reapplying for grants. This development is particularly applicable for Early-Stage Investigators (ESIs), those principal investigators who have completed their terminal degree (or postgraduate clinical training) within the last 10 years (or have not successfully competed for a National Institutes of Health independent research award during that time). Early-Stage Investigators who apply for a R01 application and receive a fundable score will automatically be considered for seven years of funding as opposed to the traditional five years, with the goal of funding 25% more ESIs in the next fiscal year. In addition, investigators may request an increase in the time for eligibility as an ESI for the purposes of non-degree research training, disability or sickness, active duty military obligation, clinical loan repayment request, or natural or other disaster relief.

Another change is the new NCI Predoctoral to Postdoctoral Fellow Transition (F99/K00) award. Piloted in fiscal year 2016, the F99 phase provides up to two years of support for a predoctoral fellow to complete graduate study. The trainee then transitions to the K00 phase for up to four years of postdoctoral training in cancer research. This award positions the fellow to later compete more effectively for the K99/R00, another award to facilitate a successful transition between postdoctoral and faculty positions. In fiscal years 2016 and 2017, the F99/K00 program received 166 applications with a 38% success rate.

In addition to the changes above, effective May 2017 the NCI no longer participates in the K23 career development funding mechanism. Historically, K08 and K23 mechanisms have both supported early-career physician scientists. The K08 awards focused on basic, behavioral and translational research while the K23 awards focused on patient oriented research. However, the separation of basic/translational vs clinical research is inconsistent with the NCI emphasis on interdisciplinary training. Therefore, rather than the K23 funding mechanism, all physician scientists applying for NCI support are encouraged to seek out for the Mentored Clinical Scientist Research Career Development (K08) award. The K08 provides support and protected time to early-stage clinician scientists who wish to explore any basic, translational, or patient oriented, cancer research. Additionally, the NCI increased the level of research and salary support for the K08 to encourage individuals to leverage this mechanism, which is anticipated to maintain a success rate of approximately 25%.

As the NCI continues to strengthen its support for applicants in training or in transition stages, the AUA Office of Research will work to ensure that urologic oncology researchers have the tools, training and information needed to successfully compete for extramural grant funding. For instance, the inaugural AUA online research education course titled “Writing a Successful Career Development Award Application” was added to AUA University in November 2018. The course was written by NIH-funded urology researchers and will help prepare early-career investigators to write a strong career development award application. We encourage all early-career investigators to explore this new educational opportunity.

Erika Ginsburg, MA, NCI Center for Cancer Research, contributed to this article.

Collaborating for the Advancement of Interdisciplinary Research in Benign Urology: NIDDK George M. O’Brien Centers

By Kristina L. Penniston, PhD – Director, O’Brien Urology Research Centers Interaction Core, University of Wisconsin
Chris Mullins, PhD – Program Official, O’Brien Urology Research Centers, NIDDK
Tamara Bavendam, MD, MS – Project Scientist, O’Brien Urology Research Centers, NIDDK

Despite advances in the clinical management of many urological conditions, millions of Americans remain afflicted with benign conditions of the bladder and urogenital system. These conditions include urinary tract infections, urolithiasis, chronic pelvic pain syndrome, prostate enlargement, erectile dysfunction and sequelae related to lower urinary tract symptoms and dysfunction (e.g., urinary incontinence, over/underactive bladder and bladder outlet obstruction), among others. Benign urological conditions affect people in the prime of their lives, are frequently chronic and typically worsen with age. While the annual treatment cost of these illnesses exceeds $11.5 billion, the cost to patients is inestimable as these conditions have myriad effects on patients’ quality of life and on their occupational, social and emotional functioning.

Named after a United States congressman from Illinois who died from prostate cancer, the National Institutes of Health (NIH) created the George M. O'Brien Kidney and Urologic Research Centers Program in 1987 to address significant gaps in knowledge related to the epidemiology, etiology, development, progression and expression of benign and malignant disease. The program has since provided funding for a diversity of basic, translational and clinical research into kidney and urologic conditions. In 2012, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) transitioned the O’Brien Urology Research Centers to a cooperative agreement (U54) acknowledging the changing overall nature of the scientific enterprise towards interdisciplinary effort and embracing integrated research efforts within the broader urologic research community.

The newly termed O’Brien Urology Cooperative Research Centers include not only Research Projects and Biomedical Cores, but also Educational Enrichment Programs and an Opportunity Pool to support additional eligible scientists in the community, including early-stage investigators or established investigators new to benign urology research. Through these activities, the O’Brien Urology Cooperative Research Centers conduct high-impact research and foster research and training in the larger benign urology research community. Four institutions have been granted these awards: Mayo Clinic (2013-2018; PI, John Lieske, MD); University of Wisconsin-Madison (2014-2019; PI, Will Ricke, PhD); Columbia University (2014-2019; PIs, Cathy Mendelsohn, PhD; Jonathan Barasch, MD, PhD; and Ali Gharavi, MD); and University of Pittsburgh (2016-2021; PI, Zhou Wang, PhD). Funding Opportunity Announcements soliciting applications for O’Brien Urology Cooperative Research Centers are issued by the NIDDK approximately every year depending on the availability of funds. The next such solicitation is expected in early 2019.

Through the O’Brien Urology Cooperative Research Centers’ efforts and collaboration with the larger urologic research community, we anticipate continued and significant advances in our understanding of the mechanistic changes of the urogenital tract in disease and health and translation of these breakthroughs toward improved clinical care of patients with benign urologic conditions.

Urologic Disease and Sexual Dysfunction in Diabetes – Diabetes in America, 3rd Edition

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) recently published Diabetes in America, 3rd Edition, which contains a chapter focused on the relationship between diabetes and urologic disorders. The chapter begins with several sections that examine the association of diabetes with lower urinary tract symptoms, benign prostatic hyperplasia and erectile dysfunction in men. These are followed by an evaluation and summary of the clinical and epidemiologic literature pertaining to diabetes and urinary incontinence and sexual dysfunction in women. Classifications, pathophysiology and data sources and their limitations are discussed throughout. View this important publication today!

2018 Bladder Health Alliance Roundtable Meeting Convenes in Washington, DC

The Bladder Health Alliance (BHA) was formed in 2013 and aims to raise awareness and reduce stigma associated with conditions impacting bladder health. Since the group’s inception stakeholders including patients, physicians and research advocacy organizations have worked together to grow both the scope of the Alliance’s advocacy efforts and the number of participating organizations.

More than 25 advocacy organizations convened at the 2018 BHA Roundtable Meeting on October 6 in Washington, DC to discuss the value of patient centered care plans, how to elevate conversations about bladder health between patients and providers, and continuing advocacy efforts for urologic research funding.

The meeting's keynote presentation featured an overview of the National Institutes of Health (NIH) by Dr. Tamara Bavendam, Senior Scientific Offer for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Dr. Bavendam explained how patient advocates can effectively interact with NIH and outlined several urology focused cooperative networks within NIH. Various types of research strategies that are used by researchers to customize treatment plans for patients were also discussed.

Drs. Toby Chai and Stephen Zderic led a session titled “Research Advocacy Efforts: Incorporating the Patient Voice,” which included an overview of the AUA’s Research Advocacy Committee’s key initiatives. The session culminated in an engaging discussion about ways that patient advocacy organizations can strengthen research advocacy efforts that result in designated funding for urologic research and innovative treatment therapies for patients.

The BHA meeting also included a congressional reception on Capitol Hill where participants networked with presenters and peers. Rep. George Holding (R-NC-2), who sits on the House Ways & Means Committee, attended the event and spoke with attendees about the value of urologic research and how allocated research funding plays a pivotal role in bringing new treatment therapies to patients.

After proclaiming November as Bladder Health Month in 2016, the BHA uses the annual Roundtable Meeting as an opportunity to discuss Bladder Health Month awareness activities. These cohesive efforts raise awareness about various bladder health conditions including overactive bladder, stress urinary incontinence, bladder cancer, urinary tract infections and interstitial cystitis, and encourage individuals across the country to become informed about these conditions and talk to their healthcare providers about the most effective ways they can actively manage their bladder health.

Are You Recruiting?

We encourage the submission of employment opportunities in urologic research—trainees and faculty only—to be posted in our next issue. Submission is no guarantee of publication. Please contact the AUA Office of Research with any questions.