Shining a little light on peer review debates

A healthy system of peer review will sometimes lead to differences of opinion on how to adjudicate an article. Consensus is the easier outcome to decide. What should an editor and associate editorial team do with conflict? We have two recent debates for further discussion. In the first, the issue revolves around what to do when an article has a heavy degree of industry participation. This can come in the form of industry employees as authors, or clinicians/researchers as authors who have consulting/advisory roles with the same company. Neither the extreme of ignoring such conflicts of interest nor rejecting any industry participation would make sense. Disclosure is certainly required, but I think there can be room for improvement. The dialogue we have had as a team reminds me of a personal project from several years ago that involved Intuitive Surgical. The company has a medical affairs group interested in research in robotics, and they purchased access to a proprietary database called Premier Perspective. Our team consisted of a medical affairs researcher from Intuitive, an independent biostatistician and two robotic surgeons, including myself. We investigated several topics such as learning curves for surgeons and complications. When we went to publish, we had several rejections based upon the mere presence of an industry-employed author. This was somewhat surprising to me; as in separate projects with the biomarker industry, I could point to two different companies with scientific-focused employees who were included as authors in well over 20 papers each. We were eventually successful in publication and included a highly detailed conflicts of interest statement in our cover letter to the editor. Specifically, we pointed out that the data were obtained from a proprietary third-party source that could be ‘fact checked’ by anyone with access. We had a third-party statistician do the analysis. We had two clinicians write the paper. Thus, no one from industry had direct access to the data, the statistical work, nor exclusive editing of the paper. So beyond just acknowledging conflicts of interest, I think collaborative authorships with industry can be more transparent with their disclosures as to how the data are collected and controlled, and the specific involvement of industry authors versus the clinical/academic authors. The second internal debate has been settled and will be reviewed below as reference #10 in this issue. This is a Health Services Research (HSR) type of paper with the aim of studying diagnostic trends in men with castrate resistant non-metastatic prostate cancer. The authors had access to a large Canadian database, but they ran into a difficult problem as the database did not specifically stage the patients as non-metastatic. Therefore, the authors had to come up with a proxy definition. Some of our reviewers thought this to be a significant limitation in methodology. But others, including myself, were impressed with the degree of creative work that the authors put in to not only proposing a proxy definition of a cancer stage but also validating the definition in another population group with known staging. I think the article has value for readers interested in the topic of focus and also for any HSR researcher who wants to study up on how another group handled a critical obstacle in a dataset of interest. In both cases, the editorial teams had to resolve conflict. In some journals with a primary focus on a high impact factor score, the resolution is often to reject such papers. For journals with a sound science focus, the decision must be made differently. Can a paper be improved? Can a paper be well aligned between methods and conclusions? Rejecting a paper may be the right decision in some circumstances, but it does effectively block access to data for the public. The first paper may have some biases from industry participation, yet the study was IRB approved, and the data should be shared, along with proper disclosures. The second paper may be flawed from the proxy definition, but that point is worth public access and further debate. We have three research communications in this issue—a growing trend that we will add to with its own ‘To the ___’ theme. As a recap, a research communication is a short format article on a focused point. It has a much shorter word limit and reference section as per the author guidelines. Many journals have these article types and call them different things like a forum, comment or brief communication. Ever wonder why? The reason is that these articles may not be counted in the denominator of sourced articles that count for the impact factor of a journal. If they are cited, they can count towards the numerator. Therefore, they are sort of ‘risk-free’ for a journal for the impact factor, and the contents can be more varied in subject matter. Russell et al.1 performed a patient survey study in bladder cancer in the second wave of Covid-19—digital in format and recruited with support group and social media platform support. They had previously surveyed patients during the initial pandemic wave in 2020. The questions focused on service disruptions and anxiety around Covid-19 affecting treatments. They noted many positive changes between initial and second wave. Their figure nicely summarises the survey results. As an aside, from our website you can view/enlarge figures or download them straight to a PowerPoint file, which may be a nice feature if you should use one of our articles for a talk. Garg et al.2 performed an observational pilot study of patients with renal cell carcinoma and caval thrombus with a focus on haemodynamic changes during the steps of the operation. Their table lays out four key measurements—mean arterial pressure, cardiac index, stroke volume variation and systematic vascular resistance per 10 steps of the procedure. Ligation of the lumbar vessels was an example of a critical change in haemodynamics—increases in stroke volume variation and decreases in mean arterial pressure. Other changes are described around caval clamping and case close. Overall, this study is an interesting illustration of how to potentially plan on the anaesthetic management of these complex cases. Thakker et al.3 performed an online survey study with the interesting focus on the topic of sleep disturbances affecting caregivers of prostate cancer patients. As their visual abstract figure summarises, 78% of caregivers met criteria for poor sleep, 43% used medications to help with sleep, and 25% met criteria for clinical insomnia. There are limitations to their methods as noted but a clear message that the concept is real and care efforts/attention need to focus on the patients as well as their immediate caregiver teams. For our review article this issue, Soputro et al.4 review the diagnostic performance of regulatory approved urinary biomarkers for investigating primary haematuria for bladder cancer. Of 18 studies of six biomarkers analysed, the sensitivities ranged from 0.659 to 0.973 and specificities from 0.577 to 0.833. This is a very thorough review and despite varying performance metrics, none rose to the level of being a general application to rule out the needs for cystoscopy. The authors discuss future directions around refined screening/evaluations for higher risk populations. Davik et al.5 present a risk stratification study aimed at reducing some of the up-front need to perform MRI and/or prostate biopsies in men being screened for prostate cancer. Most risk calculators were developed based upon common clinical variables, while incorporation of MRI came later—a balance of increased discrimination at the added cost of MRI examination, which is highly variable worldwide. Several scenarios are presented including a predicted ≥10% clinically significant cancer threshold to save 15% of MRIs and only missing 0.8% clinically significant cancers. It is an interesting and needed concept and many will want to see follow-up comparisons with secondary biomarkers to possibly exclude patients needing MRI. In my practice, I still see referrals for screened patients who are well beyond the peak ages for screen-detected prostate cancer benefit. These secondary measures, whether MRI, secondary biomarkers or risk calculators have been helping in reducing unnecessary biopsies. Jakobsen et al.6 performed a patient-reported outcome measures study from a Danish population undergoing surgery for penile cancer. Tab. 2 shows a key summary of the data collected at baseline, year 1 and year 2. The trends include baseline erectile dysfunction of 49% which increased to 69%. Other reported measures included urinary incontinence, and broader questions around sexuality. The authors discuss the topics of symptoms and distress following penile cancer surgery—somewhat expected results, but now as reported by patients. Grenabo Bergdahl et al.7 provide a series of ‘beyond feasibility’ data for post chemotherapy testis cancer selected for robotic resection. From two Swedish centres they had 87 cases over a four-year period and median 23-month follow-up. Approximately a third were selected for robotic RPLND, and the 19 presented were post chemotherapy. The key metrics were no in-field recurrences but 4/19 had chylous leaks. The leaks were a contrast with the typical outcomes of low blood loss and hospital stay. The authors discuss these metrics across the range of open and robotic series in the post-chemotherapy setting as well as selection criteria. Bolton et al.8 present an interesting observation among patients with biochemical recurrent prostate cancer imaged with PSMA PET imaging. In a small series treated with salvage lymph node dissection there was a dominant histologic subtype of cribiform pattern disease in the nodes. The authors discuss the need for further investigations and how such a predisposition may help management of patients with cribiform disease in their primary tissue specimens. Kwok et al.9 performed a practical study in kidney stone disease. Everyone says to drink more water for prevention, but what is in the water? They looked at tap water across several Australian cities as well as bottled water. For tap water there was considerable variation in levels of calcium, magnesium, bicarbonate, sodium, potassium and sulphates. Bottled sparkling water had higher than average calcium, magnesium and bicarbonate levels. The authors discuss how for a particular recurrent stone former, the region may affect whether or not they should hydrate with tap versus bottled water. Malone et al.10 performed a pattern of care study for non-metastatic castration-resistant prostate cancer. They were interested in PSA testing in this population and imaging utilisation. They found under-utilisation of both and discuss guidelines for monitoring this population at risk for progression. These are important messages to consider, given this space of patient management has new data on androgen receptor blocker drug options as well as advanced PET imaging. Sasaki et al.11 looked at prognostic differences among grade group 4 subgroups after surgery. Increasingly, pathology groups are reporting percent Gleason score 4 components, and better recognition of tertiary patterns. This group looked at the various Gleason 8 sum possibilities and found a significantly better biochemical recurrence risk for Gleason 3 + 5 versus Gleason 4 + 4 or 5 + 3 (the latter score being somewhat rare). The authors discuss grade heterogeneity and its effects on prognosis of recurrence. With our shining a little light editorial theme and the broad horizons for BJUI Compass made possible by our recent PMC index listing, our imaging themes will be sunrise pictures. These are often shot in beautiful wide-open spaces and offer a lot of colours—similar to our BJUI Compass theme colours. With the PMC listing, our issues are now indexed into PubMed. As an experiment, I searched for ‘Kukreja’ and ‘BJUI Compass’ in Pubmed.gov, and it lists our first review article with our editorial board member Janet Kukreja on enhanced recovery applications—from our first issue in March 2020. The future is bright for this journal. Enjoy this collection of images—Figures 1-8—that give a global perspective on sunrises from Australia to Europe to the United States.

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.