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HIGHLIGHTS FROM THE 2024 EUROPEAN ASSOCIATION OF UROLOGY ANNUAL MEETING
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Plenary Session: Risk-Adapted Screening and Treatment of Screen-Detected Prostate Cancer
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| Risk Adapted Screening for Prostate Cancer in Europe: PSA + MRI (OPT - the Swedish Nationwide Screening Strategy)
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| Jonas Hugosson, MD
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| Jonas Hugosson presented the Swedish national OPT (Prostate Cancer Diagnostics) approach, combining PSA and MRI screening for prostate cancer. The OPT strategy, implemented in 2020, invited men aged 50 years for screening, with those having PSA ≥ 3 ng/ml referred for MRI. The initial results showed variability in diagnostic outcomes between regions, emphasizing the need for standardization in the diagnostic pathway.
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| Risk Adapted Screening for Prostate Cancer in Europe: PSA + Risk Calculators + MRI (The EAU Screening Algorithm)
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| Katharina Beyer, Ph.D.
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| Katharina Beyer presented the EAU screening algorithm for prostate cancer, integrating PSA, risk calculators, and MRI. The algorithm aims to address the challenges of overdiagnosis and overtreatment associated with PSA testing by adopting a risk-adapted approach. Dr. Beyer discussed various algorithm variations, such as PSA followed by risk calculator and MRI before biopsy, highlighting their pros and cons.
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Plenary Session: Personalised Approaches in High-Risk and Metastatic Prostate Cancer
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| PARP-Inhibitors Only for Patients with Alterations in DNA Repair Genes: Yes |
| Elena Castro, MD |
| Elena Castro discussed the personalized approach in high-risk and metastatic prostate cancer, emphasizing that PARP inhibitors should be reserved for patients with alterations in DNA repair genes. While ARPI + PARP inhibitor trials have shown benefits in unselected patients, there's a hierarchical benefit aligned with biology, with the best outcomes observed in patients with BRCA mutations. |
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| PARP-Inhibitors Only for Patients with Alterations in DNA Repair Genes: No
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| Fred Saad, MD, FRCS
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| Fred Saad presented a counter viewpoint, suggesting that PARP inhibitors should not be exclusively reserved for patients with alterations in DNA repair genes. He argued that the combination of PARP inhibitors with non-hormonal agents (NHA) has demonstrated efficacy in both HRR-mutated and non-HRR-mutated prostate cancer patients, as evidenced by various phase 3 trials.
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| PARP-Inhibitors Only for Patients with Alterations in DNA Repair Genes: The Guidelines' View |
| Maria De Santis, MD, Ph.D. |
| Maria De Santis presented the guideline's perspective on the utilization of PARP inhibitors in patients with alterations in DNA repair genes for high-risk and metastatic prostate cancer. The guidelines emphasize the importance of offering somatic genomic testing for homologous repair and MMR defects to all metastatic patients early in their treatment journey. The EAU guidelines recommend a multidisciplinary approach for managing CRPC and emphasize the need for life-prolonging treatment with strong recommendations for molecular testing. |
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Joint Session of the EAU and the Advanced Prostate Cancer Consensus (APCCC)
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| Synchronous mHSPC: What Are the Treatment Options and What Are the Goals of Treatment? What Is the Evidence for Systemic Therapy in Synchronous Low-Volume mHSPC |
| Karim Fizazi, MD, Ph.D. |
| Karim Fizazi presented the evidence for systemic therapy in patients with synchronous, low-volume mHSPC. Key questions regarding treatment options and goals include determining the optimal duration of systemic treatments, the use of bone-protecting agents, the number of systemic treatment options to employ, differences in treatment for low- versus high-volume patients, the use of biomarkers for therapy guidance, and the role of local treatment of the primary site and directed treatment of metastases. |
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| Synchronous mHSPC: What Are the Treatment Options and What Are the Goals of Treatment? What Is the Evidence for Radiotherapy
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| Thomas Zilli, MD
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| Thomas Zilli discussed radiotherapy's role in treating low-volume metastatic hormone-sensitive prostate cancer (mHSPC). He highlighted evidence from trials like HORRAD and STAMPEDE, suggesting overall survival benefits in low-volume disease, particularly for patients with fewer metastatic sites.
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| Synchronous mHSPC: What are the Treatment Options and What Are the Goals of Treatment? What Is the Evidence for Surgery? |
| Nicola Fossati, MD, FEBU |
| Nicola Fossati discussed the role of surgery in treating synchronous metastatic hormone-sensitive prostate cancer (mHSPC). The rationale for cytoreductive radical prostatectomy lies in the 'seed and soil' hypothesis, aiming to remove the primary site to minimize metastatic spreading. While evidence for cytoreductive surgery is limited, ongoing trials aim to clarify its role, emphasizing the need for optimized patient selection and defining the optimal multi-modal strategy. |
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| Synchronous mHSPC: What Are the Treatment Options and What Are the Goals of Treatment? Germline Genetic Testing Necessary And/or Helpful? |
| Elena Castro, MD, MS, Ph.D. |
| Elena Castro discussed the significance of germline genetic testing in managing patients with synchronous mHSPC. Advancements in understanding the genomic landscape of prostate cancer indicate a growing prevalence of pathogenic germline variants, particularly in advanced stages. Germline testing not only aids in prognosis and treatment decisions but also assesses familial cancer risk, especially in identifying DNA damage response mutations and cancer predisposition syndromes. |
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Abstract Session: Intensify Treatment for Better Prostate Cancer Control
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| Three-Year Oncological Outcomes of the Randomized Phase II Trial ARNEO: Neoadjuvant Degarelix with or Without Apalutamide Prior to Radical Prostatectomy for HR Prostate Cancer |
| Gaëtan Devos |
| Gaëtan Devos presented the three-year oncological outcomes of the ARNEO trial, which assessed neoadjuvant degarelix with or without apalutamide before radical prostatectomy for high-risk prostate cancer. While patients receiving degarelix and apalutamide showed higher minimal residual disease rates than those on degarelix alone, there was no significant difference in biochemical recurrence. |
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| PSMA-PET Guided Intensification of Salvage Radiotherapy after Radical Prostatectomy: a Phase 2 Randomized Controlled Trial |
| Colin Belliveau, MD |
| Colin Belliveau presented the results of a phase II randomized controlled trial evaluating PSMA-PET guided intensification of salvage radiotherapy following radical prostatectomy. The study showed that PSMA-PET guided intensification significantly improved failure-free survival outcomes, suggesting its potential to enhance prostate cancer control. These findings support the prioritization of PSMA-PET/CT guided salvage radiotherapy for post-prostatectomy patients, pending further validation in larger trials. |
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| PSICHE Trial: PSMA Guided Approach for Biochemical Relapse After Prostatectomy- A Prospective Trial
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| Giulio Francolini, MD
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| Giulio Francolini presented the results of the PSICHE trial, which evaluated a prostate-specific membrane antigen (PSMA)-guided approach for managing biochemical relapse following radical prostatectomy. The study showed promising results, with the majority of patients remaining free from ADT and avoiding unnecessary treatment toxicity.
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| Efficacy of Transrectal and Transperineal Prostate Biopsy in Detecting Clinically Significant Prostate Cancer: Results of the ProBE-PC Randomised Clinical Trial |
| Badar Mian, MD, FACS |
| Badar Mian presented the findings of the ProBE-PC randomized clinical trial, which compared the efficacy of transrectal and transperineal prostate biopsy in detecting clinically significant prostate cancer. The study, designed to address the lack of level 1 evidence in this area, showed no significant difference in cancer detection rates between the two biopsy techniques. |
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| Living with a Prostate Cancer Patient: Real-World Evidence from the Unprecedented Europa Uomo Prostate Cancer Partners in Europe Research (EU-ProPER) Study
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| Andre Deschamps, MD, MBA
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| The EU-ProPER study presented at the 2024 EAU Congress evaluated the real-world impact of prostate cancer and its treatment on partners of patients. Findings revealed that partners often experience lower physical quality of life, changes in their relationship dynamics, and significant impacts on sexual and social aspects of life. The study highlights the need for improved support and information provision to address the diverse needs of both patients and their partners throughout the prostate cancer journey.
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| Intraductal Prostate Cancer Affinity for Lymphatic-Predominant Metastases Through 18F-DCFPyL-PSMA-PET/CT Scans in Pre-Treatment Prostate Cancer Patients |
| Rui M. Bernardino, MD |
| Rui Bernardino presented findings at EAU 2024 suggesting that the presence of intraductal prostate cancer on biopsy is associated with a 3.03-fold increased likelihood of lymphatic metastases detected by 18F-DCFPyL-PSMA-PET/CT scans in pre-treatment prostate cancer patients. This association highlights intraductal prostate cancer as a potential predictor of lymph node involvement, particularly in patients with Gleason Grade Group 2 and 3 prostate cancer, which could impact treatment decisions. |
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