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HIGHLIGHTS FROM THE 2024 EUROPEAN ASSOCIATION OF UROLOGY ANNUAL MEETING |
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Plenary Session: Controversies on GU cancer staging: Is it only imaging?
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| Disease Characterization: Advantages and Pitfalls of Molecular Imaging
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| Ken Herrmann, MD
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| Ken Herrmann discussed the advantages and challenges of molecular imaging for characterizing prostate cancer at the 2024 EAU Congress. He highlighted the FDA-approved PET tracers for prostate cancer staging, including 68Ga-PSMA-11 and 18F-DCFPyL, and presented studies demonstrating their efficacy in detecting pelvic nodal metastases and high-risk disease.
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| Disease Characterization: Are Biomarkers Better? |
| Brian Chapin, MD |
| Brian Chapin discussed the potential of biomarkers in enhancing disease characterization for prostate cancer. While current risk stratification heavily relies on stage, histology, and biology, biomarkers like Decipher and ArteraAI are emerging as valuable tools. These biomarkers offer prognostic information regarding disease progression, biochemical failure, distant metastasis, and prostate cancer-specific mortality, particularly beneficial for intermediate and high-risk patients considering radiation therapy with or without androgen deprivation therapy. |
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| The PSMA M1a Positive Patient: Treat as M1 |
| Christopher Sweeney, MBBS |
| Christopher Sweeney discussed the treatment approach for patients with prostate-specific membrane antigen (PSMA)-detected M1a disease. He argued that these patients should be treated similarly to those with 'classic' metastatic disease on conventional imaging. Dr. Sweeney presented evidence from trials such as STAMPEDE-Abiraterone and PEACE-1, suggesting that intensified systemic therapy, including androgen receptor pathway inhibitors, may benefit patients with PSMA-detected M1a disease. |
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| The PSMA M1a Positive Patient: Treat as M0 |
| Henk van der Poel, MD, Ph.D. |
| Professor Henk van der Poel discussed the management of prostate-specific membrane antigen (PSMA)-detected M1a disease, suggesting it should be treated similarly to conventional imaging-detected M0 disease. He highlighted the increasing recognition of M1a disease with PSMA PET imaging and proposed a treatment approach involving prostate-directed therapy based on the location of M1a disease. |
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| Controversies in Initial Staging for Renal Cell Cancer: Evaluation with Conventional Imaging Is Enough
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| Jean-Christophe Bernhard, MD, Ph.D. |
| Jean-Christophe Bernhard discussed the utility of conventional imaging in the initial staging of RCC, arguing that it is sufficient for accurate detection, characterization, and staging of renal masses. While conventional imaging modalities like ultrasound, CT, and MRI have limitations, such as poor predictive accuracy for certain disease stages, emerging techniques like contrast-enhanced ultrasound and machine learning algorithms show promise in overcoming these shortcomings. |
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| Controversies in Initial Staging for Renal Cell Cancer: Evaluation with Molecular Imaging Is the Way to Go
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| Peter Mulders, MD, Ph.D.
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| Peter Mulders discussed the importance of molecular imaging evaluation for the initial staging of renal cell cancer. He highlighted the limitations of anatomic imaging in distinguishing between benign and malignant renal masses and the significance of identifying clear cell RCC, which accounts for a majority of RCC-related deaths.
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| Controversies in Initial Staging for Renal Cell Cancer: Biopsy and Pathology Is the Solution |
| Yves Allory, MD, Ph.D. |
| Yves Allory emphasized the role of renal mass biopsy and pathology in the initial staging of RCC. He highlighted that while renal mass biopsy is not typically used for staging, it is crucial for confirming diagnosis in cases where imaging alone is inconclusive. He presented data showing the reliability and safety of renal mass biopsies, underscoring their importance in accurately diagnosing a wide range of renal tumor types, including benign lesions, and guiding treatment decisions. |
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| No Need for TURBT, VI-RADS Makes the Diagnosis |
| Valeria Panebianco, MD |
| Valeria Panebianco discussed the Vesical Imaging-Reporting and Data System (VI-RADS) as a potential alternative to or complement for transurethral resection of bladder tumor (TURBT) in diagnosing bladder cancer. VI-RADS utilizes MRI to evaluate the likelihood of muscle invasion, offering standardized imaging and reporting to improve diagnostic accuracy. |
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| Controversies in Initial Staging for Bladder Cancer: TURBT Is Mandatory Before Any Treatment |
| Toine van der Heijden, MD, Ph.D. |
| Toine van der Heijden emphasized the indispensable role of TURBT in the initial staging of bladder cancer and its necessity before any treatment. TURBT remains crucial for histologic diagnosis, determining tumor heterogeneity, detecting carcinoma in situ, and assessing prostatic urethral involvement and lymphovascular invasion. Despite the importance of imaging modalities like CT, which aids in staging, TURBT is essential due to its diagnostic accuracy and therapeutic implications, especially for neoadjuvant chemotherapy and trimodality therapy. |
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| Disease Characterization: FDG-PET For Staging, Is It Mandatory? |
| Sharokh Shariat, MD |
| Sharokh Shariat discussed the role of fluorodeoxyglucose (FDG)-positron emission tomography (PET) in staging bladder cancer and whether it is mandatory. While FDG-PET/CT has shown promise in improving sensitivity for lymph node staging compared to conventional CT, its utility in pre-operative evaluation and treatment decision-making remains under scrutiny. Studies have highlighted the potential of FDG-PET/CT, especially in predicting nodal involvement and guiding personalized treatment strategies. |
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| Initial Staging in Bladder Cancer: Histologic Subtype, Molecular Phenotype, and Biomarkers Are Enough |
| Eva Comperat, MD, Ph.D. |
| Eva Comperat discussed the significance of histologic subtypes, molecular phenotypes, and biomarkers in characterizing bladder tumors. She emphasized the importance of reporting histologic variables recommended by the ICCR and highlighted studies showing the prognostic and therapeutic implications of variant histology. Additionally, she outlined the use of molecular subtyping to further risk stratify patients, guide treatment decisions, and predict response to neoadjuvant chemotherapy, while also addressing the challenges and ongoing research in this field. |
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| The SPARC Initiative (Standardized PSMA PET Analysis and Reporting Consensus) |
| Anders Bjartell, MD, Ph.D. |
| Anders Bjartell introduced the SPARC (Standardized PSMA PET Analysis and Reporting Consensus) initiative, emphasizing the need for standardized communication between nuclear medicine physicians and clinicians regarding PSMA-PET/CT imaging. With the increasing use of PSMA-PET/CT in both initial staging and recurrent settings, the SPARC project aims to establish a unified framework for PSMA PET reporting by combining existing classifications and recommendations. |
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