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Objectives To outline the principles and premise, pros and cons of the use of preference signaling (PS) in the Urology Match. Methods PS is a standardized system in which a student may send a signal or token to a particular program to demonstrate genuine interest in advance of application review and interview selection. The available literature of the use of PS in other fields was assessed and applied to the unique construct of the Urology Match. Potential benefits and challenges are discussed and a process and timeline for implementation are presented. Results PS requires a limited number of signals to maintain value, a transparent system to disclose and distribute signals and continuous data assessment for optimization. It standardizes pre interview communication and highlights for programs which applicants have sincere interest although it does not directly address application overload. Conclusion PS is a viable and equitable method for applicants to indicate interest directly, confidentially and intentionally indicate interest in a program which can allow a program to maximize scarce resources such as time and interview slots in the match process.

The number of practicing female urologists has increased from < 2% in 1980 to 9.2% in 2018. Despite this increase, urology trails far behind medical fields overall, and surgical subspecialties, in achieving gender parity. Barriers, such as pervasive biases and institutional policies, exist at the medical student, resident, and practicing urologist levels. Once recognized as detrimental, action can be taken to combat these forces to allow for advancement of women in the field of urology. This will result in a richer workforce better able to serve its patient population and advance the field.

Introduction Prostate specific antigen use in prostate cancer screening has undergone significant changes since the 2012 release of the USPSTF (United States Preventive Services Task Force) guideline statement. The effect on specific primary care provider practice patterns and attitudes is not well characterized. We describe the impact of the USPSTF statement on prostate cancer screening practices, attitudes and knowledge among primary care providers. Methods A survey composed of 25 questions was mailed electronically to approximately 350 primary care providers within a single academic health care system. Responses were recorded and could not be traced to the respondent. Results A total of 73 primary care providers (21%) responded to the survey. Of the respondents 75% reported a change in prostate specific antigen screening practices resulting from the USPSTF recommendations and 35% reported a decrease in digital rectal examination use, although the latter test is not explicitly addressed in the guideline statement. A third of respondents believe that prostate specific antigen screening has “likely had no role” in the 2-decade decline in prostate cancer mortality and 70% agree that prostate specific antigen screening may “impart more harm than good” to the patient. Despite these opinions, there was markedly greater concern for medicolegal consequences of a missed diagnosis compared to over diagnosis. Conclusions The results of the survey, while limited to a single large academic center, show the impact of the USPSTF 2012 statement on physician attitudes and practice patterns. The results define the need for more educational opportunities for primary care providers regarding the USPSTF statement, American Urological Association guidelines and identification of patients appropriate for prostate specific antigen screening.

The primary aim of this review is to: (1) adequately define Match violations, (2) thoroughly examine the nature and scope of Match violations in the American Urologic Association (AUA) Urology Match, and (3) propose and recommend policy guidelines, including consequences for applicants and programs, as it pertains to Match violations. These recommendations are intended to affect change at the level of the AUA and Society of Academic Urology (SAU) that more effectively mitigates future violations, intentional or not. There is a paucity of specific guidelines published by the AUA on what constitutes a Match violation. Furthermore, in contrast to the National Resident Matching Program (NRMP), the AUA is surprisingly lenient in their existing guidelines. The Match violations most frequently reported were programs asking applicants illegal and restricted questions as well as inappropriate post-interview communication between applicants and programs. Review of current Match policies and violations suggest several areas for improvement, particularly regarding the specificity of AUA guidelines to define Match violations, the asking of illegal interview questions, and post-interview communication. The obligation to uphold a fair and equitable Match is an ethical imperative for the urologic community.

Atypical small acinar proliferation (ASAP) occurs in approximately 5% of prostate biopsies. Approximately 30–40% of patients with ASAP may develop prostate cancer (PCa) within a 5-year period. Current guidelines recommend a repeat biopsy within 3–6 months after the initial diagnosis. Our objective was to examine the association between ASAP and subsequent diagnosis of high-grade PCa and to evaluate the need for immediate repeat biopsy. A retrospective multi-institutional review identified 264 patients who underwent prostate biopsy from 2000 to 2013 (Brown), 2008 to 2013 (University of Massachusetts) and 1994 to 2005 (Mayo) and were diagnosed with ASAP. Patients underwent transrectal ultrasound-guided biopsies for elevated PSA and/or abnormal digital rectal exam. Clinicopathologic features were assessed, including rates of subsequent PCa detection of any high-grade (Gleason 7–10) PCa. Comparison was made between those with subsequent PCa on repeat biopsy and those with benign repeat pathology. All 264 patients included underwent repeat biopsy with a median follow-up of 5.4 years (interquartile range: 4.6, 6.7). Of these patients, 89 (34%) were subsequently diagnosed with PCa including 21 (8%) with high-grade PCa. Pre-biopsy PSA was higher among patients subsequently diagnosed with (6.7 vs 5.8, P