The face of prostate cancer has been dramatically changed since the late 1980s when PSA was introduced as a clinical screening tool. More men are diagnosed with small foci of cancers instead of the advanced disease evident prior to PSA screening. Treatment options for these smaller tumors consist of expectant management, radiation therapy (brachytherapy and external beam radiotherapy) and surgery (cryosurgical ablation and radical prostatectomy). In the highly select patient, cancer specific survival employing any of these treatment options is excellent, however morbidity from these interventions are significant. Thus, the idea of treating only the cancer within the prostate and sparing the non-cancerous tissue in the prostate is quite appealing, yet controversial. Moving forward if we are to embrace the focal treatment of prostate cancer we must: be able to accurately identify index lesions within the prostate, image cancers within the prostate and methodically study the litany of focal therapeutic options available.

Most abstracts fail to provide the necessary information to assess methodological quality. Organizers of urological meetings should consider implementing a more structured abstract format that requires authors to provide the necessary study details, thereby allowing urologists to critically appraise study validity.

Since it was introduced in 1999, the da Vinci Surgical System has become an integral tool in urologic surgery, specifically in the management of localized prostate cancer. The original technique of robot-assisted laparoscopic prostatectomy (RALP) was developed and standardized in 2000 at the Institut Mutualiste Monsouris. Since that time, the technique of RALP has undergone various modifications. The driving force behind the evolution of the RALP technique in the past decade has been based on efforts to improve upon the three main objectives of surgery, namely the 'trifecta' of cancer cure and the preservation of potency and of urinary continence. In this review, we aim to provide an update on the midterm oncologic outcomes of RALP and focus specifically on two technical modifications that have been introduced in an effort to optimize the outcomes of potency and earlier return of urinary continence.

Presented as Moderated Poster (Abstract 16) at the AUA Annual Meeting in Orlando, FL 17-22 May, 2008 instructions and no formal training in the application of this classification system. RESULTSOf the 86 articles, 69% related to therapy, 16% to prognosis, and 15% to diagnosis. Eight studies (9%) provided Level I evidence, 18 studies (21%) Level II, 14 studies (16%) Level III and 46 studies (54%) Level IV evidence. The intraclass correlation coefficient (95% confidence interval) based on all reviewers (eight reviewers) was 0.67 (0.59-0.74; P = 0.001) for the type of study and 0.55 (0.48-0.64; P = 0.001) for the LoE. In an analysis limited to a subset of studies in which all reviewers agreed upon the type of study question ( n = 40) the intraclass correlation coefficient was 0.79 (0.70-0.86; P = 0.001). CONCLUSIONIn the present study there was a low interobserver agreement for LoE ratings by urologists with no specific training. These findings suggest caution in the interpretation of LoE ratings and emphasize the importance of specific training for individuals that are charged with quality of evidence determinations. KEYWORDSevidence-based medicine, observer variation, urology OBJECTIVETo determine to what extent urologists with no specific training agree upon level of evidence (LoE) ratings of studies published in the urological literature, as LoE are commonly referenced as a measure of evidence quality.