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Alicia Morgans: Hi, my name is Alicia Morgans, GU medical oncologist and associate professor of medicine at Northwestern University in Chicago. I am so excited to have here with me today, Dr. Stephen Freedland, who's a professor of surgery and a urologist at Cedars-Sinai in Los Angeles, as well as being the editor in chief for "Prostate Cancer and Prostatic Diseases." Thank you so much for being here to speak with me today, Stephen.

Stephen Freedland: No, it's great Alicia to talk. With everything going on in the world, it's great to take a few minutes and actually talk with you. So it's great to hear from you.

Alicia Morgans: Wonderful. Well, Stephen, I am appreciative of your time. I know that you're certainly extremely busy, of course, being a urologist, doing all the research and all the clinical care that you do, but also being editor in chief of a wonderful journal in our field, "Prostate Cancer and Prosthetic Diseases." I'm wondering if you can tell us how things have been going from a journal perspective, as you're trying to deal with COVID, include articles, also get reviewers to contribute. How are things going in that domain of your life?

Stephen Freedland: So it's a great question. And I mean, I think in one word busy. We have definitely seen submissions go significantly up. I think it's presumably that, at least initially it started in March when things were kind of shut down in the U.S., but I mean, elsewhere in the world it's been in some cases a little bit before us here in the U.S. And people at home, clinics were shut in many cases, so we saw submissions jump about 20, 30 percent. We were already at record highs, the journals. We'd been coming off an excellent year. We had a great impact factor the year before. And so submissions basically doubled, more than doubled, in the 10 years I've been running things. And then all of a sudden, almost overnight, we saw about 20, 30 percent increase that has pretty much been sustained up until now. We saw a slight dip for July, but really slight. So it's been really a record run of submissions coming through into the journal. So very busy on that front.

Alicia Morgans: Are these submissions similar to ones that you have been getting in the past and have routinely been getting, or are they focused in a particular area?

Stephen Freedland:  Yeah, it's a great question. I would say the vast majority are typical papers of what we receive. So, I mean, we're obviously "Prostate cancer and Prostatic Diseases" is the names, so I mean, it's prostate focused. A majority of it is prostate cancer. We do some BPH and some prostatitis, but it's been a lot of prostate cancer. There's not been a huge number of like COVID specific type of papers. It's more the typical advanced prostate cancer, imaging, a little bit of basic science that we get. So the vast majority of the papers are more kind of typical what we get through. We have seen a few COVID papers come through though.

Alicia Morgans: Yeah. I think those are certainly hitting so many of our journals because it's such a topic that is top of mind, but it's interesting that as we shut down, it sounds like people were able to really wrap up some of the analyses and the work that they had been doing probably over months to years before and really kind of solidify those and get them off to the journal. It's exciting to have such a large amount of papers from which you can choose. So I'm wondering, does that lead to challenges as you try to identify reviewers to come in and sift through all these papers?

Stephen Freedland: Yeah. No, it's a great question, and the short answer is, absolutely. So we really try and ensure that each paper is given careful consideration. And for those that we do send out for review that it's three experienced reviewers, is really the goal for every paper. And so we've seen a lot of... Initially, it wasn't as much of a challenge, but I think as the papers have ramped up, so we have more going on past our initial selection onto peer review, and the reviewers themselves are very busy now that things have... It's an interesting time where things have quasi-opened, and a lot of my colleagues are talking about — and we're seeing it too — is that clinically you're actually busier than before COVID because we had several months where we couldn't see patients, so those patients are now coming through needing care.

So people are busier, but yet there's still this kind of... work at home, thus let's schedule tons of meetings... So the reviewers are scarcer to find now, and we have more papers coming through. So it's kind of a double-edged sword there, and we're still able to do it. We're still able to maintain our turnaround times. There's been some people out of the editorial office, working from home, it took them a while to adapt so that there's been some delays in the system, but overall, I think we're still meeting our metrics. We still have been very happy with things, but it is, from an editor's point of view, definitely taking more time to make sure each paper gets the careful review that we want it to.

Alicia Morgans: Well, one of the things that probably doesn't change COVID, post-COVID, pre-COVID, is that an editor's opinion and advice and guidance to those who are submitting to the journal is always an important thing to hear about. What advice would you give to people who are putting together their work and sending it into the journal for review? Do you have any suggestions?

Stephen Freedland: I think one thing I would say is, and I do this myself as an author... The advice I got is think realistically where you think your paper's going to end up and shoot for one level journal higher. And the goal for me is if I submit a paper to a journal and 100% of the time the journal says yes, and I never ever get a paper rejected, then I'm shooting too low. If 100% of my papers get rejected from where I submit, I'm shooting too high. So with our journal, the vast majority of papers get rejected. And I think that's true at any journal these days. And so what I would say is take a rejection in stride, and basically it means that the paper, either often it doesn't have the impact that you want it to. As an editor, we're really looking for impact.

So it's not always the quality of the work, though obviously that's important, but it's the impact. Is this going to make a difference in the field? And we get a lot of great papers that just have been done many, many, many times before. And so it's an easy decision for us to say, "Look, this is not the right paper for us." And sometimes authors don't like that answer, but what I would say is take the input you get from the journal, they spent time thinking about it... Even papers that don't go to peer review, I will personally write the reasons why I don't think this paper is right for us. That doesn't mean, I think it's a bad paper. Again, often there's limitations, it's been done before. And so take that advice, take it in hand, try to make it a better paper.

There's so many journals out there. Every paper can find a home, and you just need to be persistent. I mean, I've had papers that have gone to six, seven journals before it got accepted. A colleague of mine, I won't mention his name, but I think he said his record is 15 journals before a paper got accepted. So there is a home for every journal, and it's just being persistent and it takes time, but I think everything can get published. But sometimes you've just got to be persistent. Take the advice from the journals and make the paper better.

Alicia Morgans: I think that's a great bit of advice for folks because we have certainly all been in a situation where we have gotten a rejection and another rejection and perhaps even another. And that can make you feel like you should just bag the paper. But as you said, there is a home for every paper and it's important for us to continue to try because if you don't try, it will definitely not be published. So wonderful, wonderful advice. And it's interesting. I was listening to a story the other week on NPR about people who are dusting off old manuscripts and things, not necessarily scientific literature, but books that they've been writing for years. And the big piece of advice that was given to them is just because you have the time to finish it up in COVID doesn't mean that it's actually as good as you think it is — really polish it.

And as you said, take the advice from the reviewers who are taking the time to help you make that paper better, and do that. And make it a better piece. Make it more impactful if it can be or at least more succinct and clearer and send that off, and it will be published somewhere. So wonderful advice. Just any comments that you have as a physician working in the L.A. area as you're continuing to try to deal with COVID. How are things going? And what have you learned since we've all been dealing with this now for several months?

Stephen Freedland: Yeah. No, great question. So, I mean, Los Angeles is certainly seeing a resurgence of COVID numbers in the county and the city are going up. In-patient census at Cedars has slowly been going up as well. There are some..., Obviously, we're wearing masks everywhere. We're now wearing eye protection when we see patients, even in the clinic. There's still a lot of debate with each patient. Do they need to come in? Can it be video? I'm finding that with the video, it's different. In many cases, it's wonderful. But obviously you can't do an exam, and sometimes it's just not the same interaction. So I still have a lot of patients, when given the option, still want to come in. They like that human interface. Surgeries are still going forward, but we're constantly monitoring things.

And so there's a lot of concern, rightfully so, in terms of the numbers going up and it's impact. And I mean, elective surgeries delayed long enough are no longer elective. They become urgent or emergent. So it's trying to take care of all of our patients, and there's no single right answer. But for the moment, things are moving along. We're able to take care of our patients. But there's certainly, again, a couple of months of backlog from what we weren't doing in March and April, that are keeping us quite busy these days.

Alicia Morgans: Well, I wish you luck as you to help those patients in that backlog and move into this new status quo. And hopefully, as things quiet down, things can only get better. And I also want to, as we wrap up, congratulate you on 10 years as editor in chief of "Prostate Cancer and Prostatic Diseases."

Stephen Freedland: Thank you.

Alicia Morgans: And any final thoughts that you'd like to share with the listeners?

Stephen Freedland: I would say that it's a very scary time with everything that's going on. It's very easy to get isolated and depressed, but I think this is a temporary phase. We don't know how long it'll last, but there is light at the end of the tunnel and to maintain productivity, remain positive through this.

Again, a lot of people are using this time to be academically productive, to get involved in other research projects. There's a lot of ways to remain busy and productive in this kind of modern era we find ourselves. So just continue to remain positive. And in time, we don't know what that time is, but this will pass and we'll get back to a new normal.

Alicia Morgans: I would second that wholeheartedly and I appreciate your encouragement. I certainly appreciate your advice as an editor in chief, as we all try to submit papers and move the field forward. And I sincerely appreciate your time today. Thank you.

Stephen Freedland: My pleasure.