|
|
|
|
|
Highlights from the 2022 European Association of Urology Annual Meeting |
|
|
|
|
|
Controversies in Onco-Urology
|
|
| How Should PET-Detected Oligorecurrent Prostate Cancer Best Be Treated? Systemic Therapy
|
| Christopher Sweeney, MBBS
|
| The 37th Annual European Association of Urology Congress held in Amsterdam, Netherlands between July 1st, and 4th 2022 was host to a session addressing controversies in urologic oncology. Dr. Christopher Sweeney was tasked with arguing in favor of systemic therapy in prostate cancer patients with PET-detected oligorecurrent prostate cancer.
|
|
|
|
|
|
| How Should PET-Detected Oligorecurrent Prostate Cancer Best Be Treated? Metastasis-Directed Therapy
|
| Alberto Briganti, MD, Ph.D.
|
| Following Dr. Sweeney's presentation, Alberto Briganti was tasked with arguing in favor of metastasis-directed therapy in prostate cancer patients with PET-detected oligorecurrent prostate cancer. Dr. Briganti began his presentation by discussing the impact of PSMA-PET/CT usage on changes in the management of patients with biochemical recurrence (BCR).
|
|
|
|
|
|
|
|
| State of the Art Lecture: PSMA-PET/CT for Staging and Monitoring of Advanced Prostate Cancer |
| Tarik Esen, MD |
| Professor Tarik Esen discussed the role of prostate-specific membrane antigen (PSMA)-PET/CT for staging and monitoring of advanced prostate cancer. Dr. Esen began his presentation by noting that the use of PSMA-PET/CT has been incorporated into the EAU guidelines on primary staging for high-risk localized disease/locally advanced disease: “When using PSMA PET or whole-body MRI to increase sensitivity, be aware of the lack of outcome data of subsequent treatment changes.” (Strong recommendation). |
|
|
|
|
|
|
|
|
|
|
| State of the Art Lecture: Synchronous vs Metachronous mHSPC: What makes the difference? |
| Christopher Sweeney, MBBS |
| Christopher Sweeney addressed the significant clinical differences between synchronous and metachronous metastatic hormone sensitive prostate cancer (mHSPC). Dr. Sweeney began his presentation by defining patients with metachronous mHSPC as those patients who typically relapse after presentation with localized disease and were managed initially by definitive therapy with prostatectomy and/or radiation or watchful waiting. |
|
|
|
|
|
| Management of De Novo mHSPC With Oligometastases (cT3cN+cM1a): Systemic Combination Therapy Is the Best Approach
|
| Eleni Efstathiou, MD, Ph.D.
|
| Eleni Efstathiou was tasked with arguing in favor of systemic combination therapy in the management of de novo metastatic hormone-sensitive prostate cancer (mHSPC) in patients with oligometastatic disease (cT3N+M1a). Dr. Efstathiou began her presentation by noting how far along we have come in the management of mHSPC since 2014. It was not that long ago that we were debating the appropriate ADT regimen for mHSPC.
|
|
|
|
|
|
| Management of De Novo mHSPC with Oligometastases (cT3cN+cM1a): Targeted Therapy of the Primary and Metastases Is the Way to Go |
| Noel W. Clarke, MBBS, FRCS, ChM |
| Noel Clarke was tasked with arguing in favor of targeted therapy for both the primary disease and metastatic sites in the management of de novo metastatic hormone sensitive prostate cancer (mHSPC) patients with oligometastatic disease (cT3N+M1a). |
|
|
|
|
|
|
|
|
|
|
| State of the Art Lecture: mHSPC - Doublet vs Triplet Combination Therapy |
| Eleni Efstathiou, MD, Ph.D. |
| In this presentation, Eleni Efstathiou discussed the current state of doublet versus triplet combination therapy in the management of metastatic hormone sensitive prostate cancer (mHSPC). Dr. Efstathiou began by presenting the evolution of doublet therapy options (i.e. ADT + docetaxel or 2nd generation androgen receptor inhibitor [ARI]) in the mHSPC disease space from 2015 starting with the CHAARTED and STAMPEDE trials (ASCO 2015) to 2019 when TITAN and ENZAMET were presented at ASCO that year. |
|
|
|
|
|
| State of the Art Lecture: Future Perspectives in the Management of mHSPC: Where Are We Heading To?
|
| Eugen Jan Karol Axcrona, MD, Ph.D.
|
| Eugen Jan Karol Axcrona discussed future perspectives in the management of metastatic hormone sensitive prostate cancer (mHSPC). Dr. Axcrona began his presentation by noting that there are approximately 1.5 million incident cases of prostate cancer annually, with ~20% of them metastatic at presentation.
|
|
|
|
|
|
|
Improvements in Metastatic Prostate Cancer: Focus on Imaging and Treatment
|
|
| Major Adverse Cardiovascular Event Risk Following Androgen Deprivation Therapy Initiation by Cardiovascular History |
| E. David Crawford, MD |
| Crawford presented the results of his group’s study evaluating risk of major adverse cardiovascular events (MACE) following androgen deprivation therapy (ADT) initiation by cardiovascular (CV) history. Dr. Crawford began his presentation by noting that the association between ADT use and increased CV risk in PCa patients is controversial. |
|
|
|
|
|
|
|
| Exploratory Endpoints from PROpel: A Phase III Trial of Abiraterone + Olaparib Versus Abiraterone + Placebo in 1st Line mCRPC |
| Noel W. Clarke, MBBS, FRCS, ChM
|
| Noel Clarke discussed the exploratory endpoints from PROpel, a phase III trial of abiraterone + olaparib versus abiraterone + placebo in first-line mCRPC. PROpel is the first phase III study to demonstrate the clinical benefits of abiraterone + olaparib for patients in the first-line mCRPC setting enrolled irrespective of HRR mutational status. |
|
|
|
|
|
|
|
|
|
|
| Discussant: Exploratory Endpoints from PROpel, a Phase III Trial of Abiraterone + Olaparib Versus Abiraterone + Placebo in First-Line mCRPC |
| Juan Gomez Rivas, MD, Ph.D. |
| Juan Gomez Rivas discussed exploratory endpoints from PROpel, a phase III trial of abiraterone + olaparib versus abiraterone + placebo in first-line mCRPC. Dr. Gomez Rivas notes that there is an evolving treatment paradigm for prostate cancer. Among patients diagnosed with localized prostate cancer, 90% of those patients are treated with radiotherapy, surgery or active surveillance, leading to a cure in ~75% of those patients, with the remaining 25% being treated with androgen deprivation therapy (ADT) in the setting of biochemical recurrence. |
|
|
|
|
|
|
|
| A Phase III Study Comparing Diagnostic Accuracy of mpMRI Prostate to 18F-DCPyL PSMA PET/CT |
| Lih-Ming Wong, MBBS |
| Lih-Ming Wong discussed the results of PEDAL: A Phase III study comparing diagnostic accuracy of mpMRI prostate to 18F-DCPyL PSMA PET/CT. Diagnosing prostate cancer in the setting of an elevated PSA remains imperfect. MRI has helped improve the detection of clinically significant disease; however, MRI retains a false negative rate of 10-20%. PSMA-PET/CT, although currently mainly used in the staging work up of high-risk disease patients and in salvage treatment planning following biochemical recurrence post-prostatectomy and/or radiation, may be of clinical utility in this setting. |
|
|
|
|
|
| mpMRI vs 18F-DCPyL Discussant |
| Jochen Walz, MD |
| Jochen Walz led a discussion session following Dr. Lih-Ming Wong’s presentation: “Phase III study comparing diagnostic accuracy of mpMRI prostate to 18F-DCPyL PSMA PET/CT.” Dr. Walz began by noting that mpMRI has been the diagnostic standard of care for prostate cancer diagnosis since 2019. Compared to systematic biopsy alone, targeted biopsy improves detection of clinically significant prostate cancer (csPCa) as has been demonstrated in several trials such as PROMIS. |
|
|
|
|
|
| All You Need to Know About CRPC |
| PSMA Theranostics and Novel Approaches to Treatment in mCRPC |
| Alicia K. Morgans, MD, MPH |
Alicia Morgans was tasked with discussing prostate-specific membrane antigen (PSMA) theranostics and novel approaches to treatment of metastatic castration-resistance prostate cancer (mCRPC). Dr. Morgans began her presentation by giving an overview of the current mCRPC therapeutic landscape.
|
|
|
|
|
|
|
