With all the attention paid to prostate cancer research and treatment, do other aspects of urology get the research they need?

Scott A. MacDiarmid, MD, FRCPSC

“That’s a fair question, but I’m not sure how you define the right amount. There’s a lot of research. Industry does a lot in the field of voiding dysfunction and incontinence in men and women—that’s my specialty. I think they have done a nice job. I can’t really comment on kidney stones and bladder infections, but there’s no question that probably, head-to-toe, cancer gets a lot of research and financial emphasis, and maybe it should. There is, of course, is a lot of basic science research more affiliated with oncology than perhaps other disciplines.

As far as industry goes, I think they’re becoming more biased toward things that third-party payers have difficulty in saying no to, that they have to cover them. So there’s a lot of emphasis on oncology treatments vs quality of life therapies.

As I say, industry has to make money, and I only know my specialty. They go after what they would perceive, I’m assuming, can [affect] the customers— the patients and the doctors, but also what will drive economics based on the current market and demand.

I’m sort of spoiled. I do a lot of neuromodulation and overactive bladder [cases], and it appears there’s a lot of emphasis on that right now, so I’m pretty happy.”

Scott A. MacDiarmid, MD, FRCPSC

Greensboro, North Carolina

Matthew E. Karlovsky, MD, FACS

“It’s a great question. The world of cancer certainly attracts research dollars and focus…Bladder cancer—there are genomics and testing and other types of chemical instillations for bladder cancer that’s refractory to BCG. So other genitourinary cancers get their due in terms of attention and research dollars.

Alternatively, to be honest, there’s a lot of attention, time paid, and investment in what I would call the lucrative, office aspect of urology…because that helps boost the urology bottom line.

Robotic surgery is costly, in time, for the doctor and the hospital. So [although] it’s important to cure cancer, that’s not what’s carrying practices. Practices are carried by smaller, more lucrative, less time-consuming items that have plenty of research and interest in corporate industry investment.

For marginal problems such as interstitial cystitis, which doesn’t have a high interest among urologists, you’re not going to get a lot of interest or research dollars into that because basically it’s a pain. You’re not curing cancer, and it’s not a big moneymaker. If you’re not [curing cancer or bringing in a lot of money], you’re not going to get a lot of interest.

The science of stones is well-studied, so I don’t think it’s true that prostate cancer sucks up all the oxygen in the room. It’s very common, so you have a lot of [investigators] interested because they could make a name for themselves.

But there are many aspects of urology that get equal attention. Cancer will always attract attention and dollars, but it’s trickier to solve.”

Matthew E. Karlovsky, MD, FACS

Phoenix, Arizona