The great escape: A tale of the visiting professor’s Artful Dodge

In January 2001, I was a research scholar on a grant from the American Foundation of Urological Disease (now the Urology Care Foundation, under the American Urological Association) in Norfolk, Virginia at Eastern Virginia Medical School (EVMS). The EVMS residency invited Dr Mani Menon from Henry Ford Hospital in Detroit, Michigan to be our visiting professor. Dr Menon was highly focused on building a minimally invasive radical prostatectomy programme, and at this time he was transitioning from the laparoscopic method to the robotic method—a move that would fundamentally change the practice of radical prostatectomy. As with most visiting professor events, the residents present cases of interest, and while we certainly discussed a lot of prostate cancer, we thought it would be interesting to throw him a curve ball. We presented a case of hereditary renal cancer that had passed in an autosomal dominant fashion and was known to be associated with other clinical manifestations such as skin fibrofolliculomas, pulmonary cysts, and spontaneous pneumothorax. I think many of you will already recognize this as Birt-Hogg-Dubé syndrome. However, in 2001, the renal cancer aspects of the syndrome were just being described, even though early reports on the skin disorders go back to 1977. Suffice it to say, Dr Menon was officially “stumped” on any detailed discussions on Birt-Hogg-Dubé syndrome (although he did have some impressive ideas in his differential). But rather than waving the white flag, or just asking for the next case, Dr Menon did something unexpected and highly memorable. As many politicians do at debates or press conferences—if you don't want to answer the question posed, just answer a different question. So Dr Menon turned the case into a useful discussion and explanation on screening test metrics, specific to the challenges of screening for rare events like Birt-Hogg-Dubé syndrome. The key take home messages were that:


The great escape: A tale of the visiting professor's Artful Dodge
In Michigan to be our visiting professor. Dr Menon was highly focused on building a minimally invasive radical prostatectomy programme, and at this time he was transitioning from the laparoscopic method to the robotic method-a move that would fundamentally change the practice of radical prostatectomy.
As with most visiting professor events, the residents present cases of interest, and while we certainly discussed a lot of prostate cancer, we thought it would be interesting to throw him a curve ball.
We presented a case of hereditary renal cancer that had passed in an autosomal dominant fashion and was known to be associated with other clinical manifestations such as skin fibrofolliculomas, pulmonary cysts, and spontaneous pneumothorax. I think many of you will already recognize this as Birt-Hogg-Dubé syndrome. However, in 2001, the renal cancer aspects of the syndrome were just being described, even though early reports on the skin disorders go back to 1977. Suffice it to say, Dr Menon was officially "stumped" on any detailed discussions on Birt-Hogg-Dubé syndrome (although he did have some impressive ideas in his differential).
But rather than waving the white flag, or just asking for the next case, Dr Menon did something unexpected and highly memorable.
As many politicians do at debates or press conferences-if you don't want to answer the question posed, just answer a different question.
So Dr Menon turned the case into a useful discussion and explanation on screening test metrics, specific to the challenges of screening for rare events like Birt-Hogg-Dubé syndrome. The key take home messages were that: 1. The sensitivity and specificity of a screening marker (or any test) are somewhat fixed by the clinically acceptable thresholds for calling a test normal or abnormal.

NARUS.US).
Moving on to the January 2021 issue of BJUI Compass, which now features an expanded article count due to increasing volume of quality submissions, and authorship groups from around the globe including the United States, Japan, Australia, and The United Kingdom.
One of our noteworthy contributions is from the United Kingdom, Vasdev et al, 1 on a novel biomarker for urothelial cancer, and hence our theme of screening metrics. The cohort tested is a modest size of 71, but the overall sensitivity was 100% with specificity of 92.6%, and PPV 0f 95.7%. Biomarker development in bladder cancer has been ongoing for many years with a library of options available, but the question has always remained whether or not any of them can truly replace cystoscopy. Again, the prevalence has always been an issue-even with risk targeted populations. Janet Kukreja from our editorial board helped review and optimize this paper, and expands her thoughts on this biomarker in the broader context with an editorial comment. 2 We look forward to further validation studies.

F I G U R E 5
We have three papers this month form Yokohama City, Japan, which is located on Tokyo Bay. Also on the Bay is an interesting statue that will look familiar to Americans, called the Odaiba Statue of Liberty, a tribute to Japan's ties with France of urology at Eastern Virginia Medical School, and a partner with Urology of Virginia. Dr Williams did his residency at EVMS and fellowship at MD Anderson Cancer Center. He will be helping us with urologic oncology papers as well as advanced/metastatic prostate cancer topics.
Bringing it full circle will be Figures 6 and 7, my return to Norfolk as the Visiting Professor. I do not recall the residents throwing me any curve balls like we threw to Dr Menon in 2001. They wanted a graduation talk on a non-medical topic, so it will be no surprise that I talked about my experiences combining photography with academic urology.

R E FE R E N C E S
F I G U R E 7 EVMS and Norfolk sit on the inward bay/harbour part of the region to the West, but a short drive away is Virginia Beach with fantastic sunrises over the Atlantic Ocean