In the 1970s, some of the leaders in urological oncology began seriously discussing the formation of a formal society. The impetuses for these discussions were several. First, other surgical specialties had formed, or were considering forming, oncology societies. These included gynecology, ENT, and general surgery. Secondly, the National Cancer Institute (NCI) had at least two initiatives where cancer related society representation was desired. One was the NCI advisory board which was restructured in 1980 by its then director Vince de Vita. In order to have a “seat at the table,” a specialty had to have a recognized organ specific subgroup society. Urology did not have such a specialty subgroup.
Another NCI initiative was the formation of the Patient Data Query (or PDQ) System. This was intended to create a mechanism whereby physicians countrywide could access a central data base for the names of physicians who dealt with specific malignant disease processes, protocols studying these processes and their treatment, and mechanisms by which patients could be entered into these protocols. At the time there was no roster that identified urologists with a dedicated interest in the management of urologic malignancy.
Accordingly, in 1983 Dr. David Paulson sent letters outlining these issues to several urologists noted for their activity in this area and to the leadership of the AUA to advise on guidelines for an organization that could address these needs. This prompted several formal meetings at the AUA Annual Meeting to discuss the establishments of a society that would identify urologic oncologists and formalize the practice of urological oncology. Participants at these meetings varied and at times included over 20 urologists. The physicians most associated with these early meetings included Drs. David Paulson, Carl Olsson, Donald Skinner, John Donahue, Jerome Riche, Pat Walsh, Jean deKernian, and Harry Herr.
Finally, a formal organizational meeting of the Society of Urologic Oncology (SUO) was held in New Orleans on May 8, 1984 just before the AUA Annual Meeting. There, a provisional set of bylaws was approved and officers were elected to begin their terms in 1985. These urologists were Dr. John Donahue, President; Dr. David Paulson, Secretary; and Dr. Donald Skinner, Treasurer. Soon after, the NCI allowed a representative from the SUO to attend their advisory board. For many years, this was Dr. Carl Olsson. The NCI also officially recognized the SUO and included it on its list of cancer-specific organizations for the PDQ.
The formation of this Society is not without controversy. Initially opposition by some of the members of the AUA was based on concern that the creation of this Society implied the establishment of a double standard of classification of competency in the area of urologic oncology. Subcertification by the American Board of Urology, that by 2015 had occurred with pediatrics and female urology, was not even contemplated then, and most urologists prided themselves in “doing everything.” Indeed, initially even Dr. Willet Whitmore was worried about the possibility that the SUO would cause the “balkanization” of urology. Much time was spent in correspondence with the AUA describing the Society’s mission simply as supportive of the identity of urological oncology as an individual entity, with focus on attempts to understand and improve its practice. More specifically, it was explained that an objective of the Society was to bring together like-minded urologists with special interest in oncology, to fulfill an educational mission in this area, to identify opportunities to participate in research protocols, and to respond to NCI calls for representation. Gradually the AUA gave its support to the SUO. Dr. Herbert Brendler who was President of the AUA in 1983-4 was particularly instrumental in the AUA’s support.
The second meeting of the Society was held in Atlanta, GA, in 1985 during which its position in each of these issues was further clarified. Criteria for membership were established that, among other issues, required candidates to dedicate 75% of their time to urologic oncology. Affiliate membership was offered to individuals in other medical specialties with the provision that an equivalent amount of time be spent in the management of patients with urologic malignant disease. In addition, a decision was made to hold a half-day meeting for formal presentations and discussions by members on topics that were not yet ready for presentation at the regular AUA meeting.
At the first official scientific meeting of the society, held in New York in 1986 in conjunction with the AUA Annual Meeting, members of the Society presented clinical studies and protocols in progress, conducted panel discussions, and presented clinical cases. By 1987, the SUO was recognized as a group of individuals acknowledged for their expertise in urological oncology and its members as spokespeople for urologic oncology within the United States. The names and estimated tenures of all the SUO presidents are listed here.
Between 1987 and 1990, the scientific SUO meeting took place before the AUA Annual Meeting in the spring and was not listed in the official AUA meeting agenda. In 1990 the SUO meeting became part of the official AUA Annual Meeting program.
Initially the meetings were “members only.” In subsequent years, the meeting gradually opened to nonmembers and the format of the meeting changed to one of more formal presentations and debates. In 2000 the SUO held its first Winter Meeting in order to expand opportunities for its members to discuss and debate ongoing clinical and laboratory investigations in urologic oncology. It was organized by Dr. W. Marston Linehan and took place at the National Institutes of Health (NIH). The Winter Meetings continued to be at NIH until 2013 when they were moved to non-governmental sites. All of the Society’s scientific meetings are listed here and, where possible, include the agenda.
The formation of the Society of Basic Urologic Research (SBUR) prompted the SUO to develop combined meetings with this group in the presentation of basic laboratory research and urologic oncology at the time of their annual meeting. This evolved to the creation of a combined session with the SBUR during the morning of the annual SUO meeting followed by an afternoon clinical session solely for the SUO presentations. More details about the SBUR can be found at sbur.org.
Lectureships and Awards
In 1993, the Society initiated an annual award and lectureship in honor of Dr.Willet Whitmore., who had been involved in early discussions on the formation of the Society and is considered the father of urologic oncology. In 1994, Dr. Whitmore was the first speaker under the auspices of this lectureship.
In 1996 Dr. Paul Schellhammer has been approached by Zeneca representatives offering a modest contribution during a time when the society was soliciting industry for support of their annual lectureship and other activities. In subsequent discussions in 1997, Drs. Schellhammer and Droller (who was SUO president at the time) negotiated with Zeneca to effectively endow Whitmore Lectureship with the contribution of $100,000 to the Society. Contributions from the SUO membership completed the endowment. In 1995 Dr. John Donahue gave the second Whitmore lecture. In the letter that he sent in with a contribution to the Whitmore in Delmont, he commented: “which was an inspiration to me as a student and junior resident and became a trusted friend and advisor over the years. He was truly the father of American Urologic Oncology, having been the first to really understand the proper into relationship of medical oncology and surgery. He saw cancer in its biological context and all physicians interested in cancer as players on the same team. All who knew him logged in in mired him and what he stood for.”
Every year thereafter since 1995, prominent speakers who have made significant contributions to the field of Urologic Oncology have delivered the Whitmore Lecture at the Society’s Spring Meeting. The names of all the Whitmore lecturers are listed here.
Over the succeeding years, additional honorary lectureships and awards were instituted. These include the Huggins Medal established in 2001, the Young Investigators Award established in 2002, the SUO Medal established in 2003, the Distinguished Service Award established in 2005, the Best Poster Award established in 2005, and the Prostate Cancer Foundation Award which was given between the years of 2010 and 2013.
In 2016 a SUO EUA Exchange Lectureship was begun. In 2020 the Joseph A. Smith Mentorship Award was established.
In addition, three awards are now given yearly to Young Urologic Oncology (YUO) members. These three awards are the YUO Paper of the Year Award established in 2015, the YUO Best Abstracts Award established in 2005, and the best abstract awards selected for the winter meeting YOU podium session.
In 2020 the SUO established Women in Urologic Oncology (WUO) group. They instituted a best abstract by a female trainee award.
All SUO award winners are listed here.
SUO in the Present
In the late 1990s, discussions intensified on what additional activities should be conducted by the SUO. After much discussion, it was resolved that the Society should have fellowships and eventually develop a secure annual test used as a mandatory assessment of didactic knowledge among the fellows and a voluntary one for SUO members. The test was also envisioned to possibly serve as an element toward obtaining American Board of Urology (ABU) certification, much as was being considered at the time for Pediatric Urology and later Female Urology. Additional goals for the SUO included adopting its own journal, developing a clinical trials group, developing activities to encourage the participation of young aspiring urologic oncologists, and establishing communication with urologic oncologists around the world. Several of these goals were initiated during the presidencies of Dr. Richard Williams (1996 – 1997), Michael Droller (1997 – 1998), and Paul Lange (1998 – 1999); others were then carried toward fruition during the presidencies of Dr. Paul Schellhammer (1999 – 2001), Joseph Smith Jr (2001 – 2003), and Robert Flanigan (2003 – 2004).
Over the next 17 years, all these goals were accomplished except for ABU certification. Certification did not occur for several reasons most prominently because it was the general consensus of the ABU and the American Board of Medical Specialties (ABMS) that separate board certification would not move forward. However, there is desire by the SUO and the ABU to develop a focus practice designation (FDP). This goal is still developing. Key ingredients include our subspecialty immersion, the continuance of our fellowships, a certifying examination (OKAT) and criteria that will be appropriate for membership beyond for certain non-SUO members. It was also believed that we would need obtain approval from the AUA membership and executive leadership. There is still a fair amount of political work to be done to gain consensus on the latter.
In 2000, the SUO formally developed fellowship guidelines on educational objectives and curriculum. There were already several urological fellowships in existence, and these were easily approved and soon thereafter additional fellowships at academic institutions were established and accredited. Description of the early history of the SUO Fellowship Program was provided by Dr. Jeffery Holzbeierline in the May/June 2012 issue of Urologic Oncology: Seminars and Original Investigations (Volume 30, Number 3).
From the outset, the duration of the fellowship was a minimum of two years with 12 months of clinical experience and 12 months of research. Over the years and with increasing numbers of approved fellowships, more formal program requirements and oversight were established. For example, a set of essential skills required by a SUO trained urological surgeon was developed. A detailed approval or “certification” process was enacted including a formal site visit of the applicant’s program where specific formalized requirements were evaluated. Also formalized were minimum numbers and types of surgical cases, methods for monitoring both the program and the fellow, and curriculum standards both for clinical and research experiences. A national matching program for fellow selection was developed which is administered yearly by the AUA.
The fellowship program has been a great success, with 35 accredited programs in 2020. More information can be found in the fellowship section of the SUO web site.
A Secure Yearly Exam (OKAT)
Beginning in 2006, the SUO began pursuing the construction of an examination for its members to provide them with a tool that would allow for self-assessment regarding their fund of knowledge in the field of urologic oncology. An SUO committee, headed by Drs. Michael Cookson and Michael Koch,worked with the American Urological Association and American Board of Urology exam (AUA/ABU) committees to construct a written test in a format similar to the In-Service Examination. This test became known as the Oncology Knowledge Assessment Test (or OKAT).
A detailed description of the development of the OKAT can be found at Campbell SC and Cookson MS: The Oncology Knowledge Assessment Test. Urol. Oncol. 30:235,2012. Briefly, the OKAT has been securely administered annually since 2007 on the same day as the In-Service Examination. All fellows in SUO-accredited urologic oncology fellowships and their program directors are required to take the exam. In addition, all SUO members are recommended to participate in this test at least every other year. Similar to the ABU Qualifying Examination, each item is analyzed for its statistical characteristics, and those that do not perform well are deleted from the final analysis. A strong bank of validated secure questions has been accumulated in a close working relationship with members of the ABU/AUA Examination Committee. In 2019, a more formal structure for a selection of the OKAT committee chair was established. This is now performed by the ABU after a review of nominations by the SUO.
An SUO Journal
The journal Urologic Oncology was started by Dr. George Prout in 1994. Toward the end of Dr. Prout’s tenure as editor of the journal, the publication faced a number of issues that threatened its survival. Dr. Michael Droller was asked to become managing editor in 1998 and assumed the editorship on Dr. Prout’s retirement in 1999.
Dr. Droller guided the journal to achieving index status in 2000 and that same year the journal became the official scientific publication of the SUO. Shortly thereafter, Elsevier acquired W.B. Saunders, which was the publisher of a separate journal Seminars in Urologic Oncology, and whose editor was Dr. James Montie. This provided an opportunity in 2001 for the two journals to merge under the editorial leadership of Drs. Montie and Droller to become Urologic Oncology: Seminars and Original Investigations. The merged journal achieved index status the same year. Some months later, Dr. Montie decided to step down, thus leaving Dr. Droller as Editor.
Under Dr Droller’s continued editorship, he expanded the involvement of members of the SUO in production of the journal and obtain original research and seminar contributions from the SUO membership. He guided the Journal’s frequency of publication from its initial bimonthly schedule when the journal began to monthly publication to address its expanding content. He engaged members of the SUO and the YOU to participate in the review and editorial processes of the Journal. He continued to solicit involvement of multiple disciplines in urologic oncology to participate in Journal activities as contributors and editors. When the World Urology Oncology Federation (WUOF) under the leadership of Dr. Laurence Klotz joined the SUO, Urologic Oncology: Seminars and Original Investigations became its official journal as well, expanding the international outreach of both. A more detailed account of the journals history can be found at Urologic Oncology: Seminars and Original Investigations 39(2021) 514-520).
Clinical Trials Consortium (CTC)
The idea of having an SUO sponsored clinical trials initiative was discussed as early as 1999. Until that point, this initiative was an objective of only a few. However, the importance of randomized controlled trials in urologic oncology and the value and perceived necessity for the SUO to take the initiative in trail development and conduct continued and grew as an important discussion point while the SUO matured.
In 2000, Dr. Jerry Andriole introduced Dr. Sam Wells at a meeting of the SUO Board of Directors. Dr. Wells was then a general surgeon at the Duke Medical Center who was leading a surgical trials group of the American College of Surgeons Oncology Group which he had established in 1998 when he was ACS director. Dr. Wells presented the possibility and desire to include a surgical urology trial under the auspices of that group and proposed a clinical study on prostate cancer for the SUO to consider. This study would compare the results of radical prostatectomy with those of interstitial brachytherapy in the treatment of localized prostate cancer. This study was initially formulated by doctors Juliana Crook a, a radiation oncology, and Neal Fleshner, urologist, both at the University of Toronto. Later doctors Paul Lange and Paul Schellhammer convinced the Canadian group to involve the participation of American urologists in this trial. After much discussion and planning, the SUO board approve the participation of the SUO in this trial.
In 2002 the SPIRIT trial (Surgical Prostatectomy Interstitial Radiation Intervention Trial) was open and funded under the auspices of the American College of Surgeons Oncology Group. It included surgical credentialing, quality of life assessments, and multidisciplinary patient education sessions. Although the trial was forced to close two years later because of lagging accrual especially in the US, sufficient information on quality of life issues was available to permit publication of results (J. Clin. Oncology 29:362-368,2010).
Notwithstanding this somewhat unpromising start, it provided important initiative and incentive. In 2005, the SUO board of directors adapted the strategic plan to establish the SUO -Clinical Trials Consortium (SUO-CTC). In this, an important impetus for the CTC was to respond proactively to the challenges of other cancer-concerned specialties, particularly medical oncology, to further integrate the role of the urologic surgeon in the study of and active participation in the treatment of GU cancers. It was resolved that urologic oncology as a group must participate in the systemic care of the GU cancer patient and not just be involved in surgical interventions. Thus, knowledge of and activity in both local and systemic therapy was deemed essential for the uro-oncologist. Accordingly, the SUO should have greater involvement in the conduct of clinical trials. Collaboration with medical oncology colleagues was considered essential.
The impetus for the CTC was to proactively respond to the challenges of other cancer-concerned specialties, particularly medical oncology, and thus to further integrate the role of the urologic surgeon in GU cancer. It was resolved that the urologic oncologists as a group must participate in the systemic care of the GU cancer patient and not just be involved in surgical interventions. Thus, knowledge of and activity in both local and systemic therapy was deemed essential for the uro-oncologist, and accordingly, the SUO should have greater involvement with the conduct of clinical trials. Of course, collaboration with our medical oncology colleagues was also essential.
In 2007 the SUO’s Clinical Trials Consortium (SUO-CTC) was developed with Drs. Martin Gleave, Colin Dinney and Robert Uzzo as the executive leadership. Additionally they each led an organ site committee to review and facilitate clinical trials: Dr. Gleave was in charge of prostate, Dr. Dinney of bladder, and Dr. Uzzo of renal. The consortium was incorporated as a nonprofit in 2008. A formal call for sites and the launching of the first trial occurred in 2009. Thereafter the SUO-CTC grew rapidly.
In 2019, 11 trials have been completed, five are on-going and in total over 2300 patients have been accrued by the SUO-CTC to our trials. There are now over 419 members from 203 U.S. sites, with equal numbers being academic and non-academic. Additional information regarding active trials and member publications can be found on the website SUOCTC.org. A more detailed description of the CTC can be found at Shore ND, Dinney C, Uzzo R: The Society of Urologic Oncology Clinical Trials Consortium: A Brief History and Overview. Rev. Urol. 19: 1-3, 2017.
Supporting Young Urological Oncologists (YUO)
In 2003, serious discussions began on how to further encourage enthusiasm and development of aspiring young urologic oncologists. Thanks to the efforts of three young urological oncologists (Drs. Doug Scherr, Jeff Holzbeierlein, and Dan Lin), the Young Urologic Oncologists (YUO) organization was born.
- The first YUO board was initialed in 2004 with Dr. Jeff Holzbeierlein as President. Bylaws were developed and modeled after the SUO bylaws, but with a specific focus on early career urologists and trainees. The first formal YUO meeting took place at the end of the 2004 SUO Winter meeting. By 2006 this meeting became very well attended and was moved to the night before the start of the SUO Winter meeting. Thereafter the YUO meeting greatly expanded with prominent invited speakers and featured abstracts from YUO presenters. Additionally, the YUO obtained formal representation on the SUO board and became more involved in the main SUO conference program such as reviewing poster presentations and rewarding meritorious ones, having YUO speakers formally present, and influencing the conference content to focus even greater attention to the central issues surrounding urology trainees and early career investigators. As described elsewhere in this report, the YUO sponsor the following awards and programs: best abstracts, paper of the year, and best poster awards and the EAU YUO exchange program. Recently the YUO developed a presence on the internet with a Twitter account and a virtual lecture series on critical topics in controversial aspects of urologic oncology as well as professionalism and career development.
A full account of the YUO’s history can be found here.
SUO Visiting Professor Program
In 2018, the SUO established a visiting professor grant program. The program was initiated by then SUO President Dr. Leonard Gomella. This program is designed to provide a $3000 grant annually to two ACGME-approved urology residency programs in the United States or Canada. The visiting professor can be any SUO member in good standing with the program details provided by the host institution. Applications are reviewed by the Education Committee with final grant awards voted on by the SUO Board. A list of past visiting professors and the awarded institutions are listed here.
SUO Research Scholar Program
Since 2014, SUO has sponsored awards for the Urology Care Foundation’s Research Scholar program to fund exceptional early-career investigators’ projects in urologic oncology. Each year, we invite the awardees to present an update on their research and continue to be impressed by the talent and ingenuity of these young urologic oncologists.
A listing of the recipients of these awards is contained in the in the Awards section.
Women in Urologic Oncology
In 2019, a subsection of the SUO called Women in Urologic Oncology (WUO) was established. It was developed to support the increasing number of women who are in or have completed a SUO fellowship and/or members of the SUO. Starting in 2020 they launched a WUO Best Abstracts Award to be given to a female trainee presenting at the SUO Meeting.
The World Urologic Oncology Federation (WUOF)
The WUOF was founded by Dr. Laurence Klotz. The concept was a Federation of societies of urologic oncology. At its founding in May of 2005, it comprised 12 societies of urologic oncology from around the world, including the SUO. As such, it represented very diverse regions, traditions, healthcare systems, and ethnicities. The WUOF endeavored to include all urologic oncology societies in the world, and by 2021, it had grown to encompass 21 society members, representing about 8,000 urologic oncologists. A number of these regional groups have been motivated to become formal societies in order to join the WUOF.
Among its regular functions is the conduct of an annual conference where topics in urologic oncology are discussed and attempts are made to reach a consensus on specific management issues among the regional groups. At the 2006 AUA Annual Meeting, the WUOF formally adopted Urologic Oncology: Seminars and Original Investigations as its official journal, and through 2021 this relationship has continued. The WUOF is an independent Federation, formally affiliated with the Society of International Urology (SIU).
The vision of the WUOF was to serve as a forum to bring together urologic oncologists from around the world to share ideas and perspectives, and develop collaborations and friendships based on shared interests. The major focus of the WUOF is on international issues in urologic oncology; that is, how variation in cancer epidemiology, economics, the organization of healthcare systems, and regional cultural differences influences clinical practice. In so doing, global bridges between the regional societies are enhanced. The WUOF has taken on a number of other international projects, including the Global Bladder Cancer Prevention Program, whose mandate is to bring a focus on smoking cessation into the practice of Urology, and more recently responsibility for the oncology topics of the International Consultation on Urologic Diseases (ICUD). The first WUOF ICUD on Molecular Biomarkers in Urologic Oncology was produced in 2020. Dr. Klotz led the organization until 2021, when the leadership was assumed by Dr. Peter Hammerer (Germany). More about WUOF can be found at wouf.org.
SUO (YUO) EAU Exchange Program
In 2017, the SUO and EAU partnered to create an exchange program for young urologic oncologists involving separate application processes. The SUO program provides an opportunity for a YUO member within eight years of completing fellowship training to apply for a two-week scholarly visit to an institution in Europe. The visit will last two weeks and coincide with the Annual EAU congress in March which the designee will be able to attend. In return, an SUO member will host a young urologic oncologist from the EAU at his or her institution for two weeks in December, allowing the young urologic oncologist to attend the SUO Annual Meeting. More information about this program and a list of past awardees can be found in the YUO section of the SUO website.
The first SUO exchange scholar was Dr. Samuel D. Kaffenberger from the University of Michigan who visited San Raffaele University in Milan. The first EAU exchange scholar was Dr. Fabio Zattoni who visited Mayo Clinic in Rochester, MN after attending the 19th SUO Annual Meeting in 2018.
SUO-EAU Exchange Lectureships
The SUO and the EAU Section of Oncologic Urology (ESOU) established a lectureship to be given at the SUO annual meeting and the EAU annual meeting. A list of the past lectureships is found under the Awards section of the SUO website.
SUO-European Society of Oncologic Urology (ESOU) lectureships at Society of International Urology (SIU)
Since 2016, selected speakers from SUO and ESOU have comprised a session at the annual meeting of the SIU. A joint plenary session comprised of SUO and ESOU members cover critical topics in urologic oncology.