A time of change.

We are going through a time of change. Apart from the ones affecting the journal and national politics, about 3 years back, there was a paradigm shift in the government policy on medical education with an emphasis on specialist training. This resulted in a sudden increase of post-graduate training positions in surgical specialties, including Urology. Without a simultaneous increase in infrastructure or operating time in most departments, it can be argued that such an increase has possibly diluted urological training.

However, this increase in number of post-graduate trainees has some obvious benefits. The greater number of urologists will hopefully translate into more of them migrating to smaller towns to set up their practice. The number of members of the Urological Society of India is also increasing rapidly, with a proportionate increase in the number of papers submitted for presentation in its zonal and national meetings. It is interesting to note that there are more prospective trials being conducted and a greater number of research protocols being submitted to Institutional Review Boards for approval. Unfortunately, most of these trials are still not being registered with clinical trial registries. It is also not clear if the increasing number of submissions for conferences is being translated into publications. Registration of trials ensures that data of negative or equivocal studies that are not published are also are available thus improving transparency, accountability and accessibility of clinical trials. While a number of journals make trial registry a precondition to publication, it is still not the norm. Academic institutions must take a lead to ensure that trials on human subjects are registered with these registries before enrollment of the first participant.

In this the last issue for the year 2014, we have focused on prostatic cancer. With increasing life expectancy and more widespread availability of prostate-specific antigen testing, there is an increase in the detection of prostate cancer, particularly in urban India. This trend is expected to continue.[1] The number of patients who present with metastatic disease continues to be large. In this issue of the journal, Gagan Gautam writes a provocative article on the evidence for radical prostatectomy in men with metastatic prostate cancer.[2] However outrageous it may sound, a select group may be benefited. Associate Editor, Arabind Panda, provides a counter-argument.[3] The quality of evidence is low and should be interpreted accordingly. Two original articles on radical prostatectomy highlight the changes in prostate cancer occurring around the world. The first from the Weill Cornell Medical College, New York, looks at the change in pathological outcomes and operative trends with robot-assisted laparoscopic radical prostatectomy at their center, where they noted a “reverse stage migration” with increasing proportion of men undergoing surgery for extracapsular disease, while the second from India looks at continence outcomes in early-stage disease.

Continuing on the theme of prostate cancer is the symposium on newer trends in radical prostatectomy, guest edited by Professor Narmada P. Gupta. He has roped in a team of experts on the subject who have vast original experience of their own and have covered contemporary topics from neurovascular anatomy and its preservation, surgery in high-risk disease, the challenges of salvage surgery and handling difficult anastomosis with management issues of erectile dysfunction and positive surgical margins. If the increasing number of installations of the robotic systems in the country is any indication, this may become the focus of a lot of articles in the journal in the future.