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The 2026 European Association of Urology (EAU) Annual Meeting
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| How to Optimize Tissue Biopsy Acquisition? Why, Who, When, Where, and How
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| Martin Gleave, MD, FRCSC, FACS
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| Biopsy in advanced prostate cancer is crucial because it confirms diagnosis, characterizes treatment-emergent histologies, and provides tissue for genomic profiling that guides targeted therapies, family counseling, and trial eligibility. Dr. Gleave emphasized biopsying de novo mCSPC and progressing mCRPC, prioritizing metastatic sites over primary prostate in mCRPC, while using transperineal prostate biopsy when metastases are inaccessible or in newly diagnosed de novo mCSPC.
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| When to Use ctDNA in Prostate Cancer?
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| Alexander Wyatt, PhD
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| Circulating tumor DNA (ctDNA) in prostate cancer is most useful when tumor burden is high and you need real‑time genomics to guide or monitor systemic therapy. It closely mirrors tissue for DNA repair gene alterations such as BRCA2, allowing PARP inhibitor selection and then tracking response and resistance over time.
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| How to Read a Genetic Report for Clinical Practice?
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| Himisha Beltran, MD
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| To use a prostate cancer genetic report clinically, Himisha Beltran emphasized first checking tumor cellularity/ctDNA fraction to judge how reliable negative results are and how to interpret variant allele frequencies. Next, clinicians should review tumor mutational burden/MSI status for immunotherapy eligibility and then assess mutations and copy‑number changes to identify patients most likely to benefit from PARP inhibitors and to recognize resistance when BRCA reversion mutations emerge on serial testing.
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| How to Optimize Germline and Somatic Testing in Prostate Cancer?
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| Niven Mehra, MD, PhD
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| Somatic testing in prostate cancer should be done on tumor tissue (or ctDNA) in all metastatic patients to identify targetable alterations, especially HRR defects, while recognizing that somatic panels also often flag possible germline variants. Germline testing remains essential when guideline criteria are met, because tumor‑only sequencing can miss 10–20% of pathogenic germline variants; therefore, tumor findings should prompt confirmatory germline testing, and tumor‑only approaches should not yet replace dedicated germline assays.
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| State of the Art Lecture: Why Are Germline and Somatic Alterations in Prostate Cancer Important?
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| David Olmos, MD, PhD
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| Germline and somatic DNA repair alterations, especially BRCA2/BRCA1, are common in advanced prostate cancer and are strongly associated with worse progression‑free and overall survival. Identifying these HRR mutations is crucial for family risk counseling and for therapy selection (including PARP inhibitors), with a few non‑BRCA genes such as FANCA and CDK12 also signaling particularly aggressive disease.
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| State of the Art Lecture: PARP Inhibitors in mHSPC and mCRPC
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| Gerhardt Attard, MD, PhD, FRCP
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| PARP inhibitors clearly improve outcomes in BRCA1/2 mCRPC, both as monotherapy after ARPI and in first‑line ARPI combinations, and are now also showing benefit earlier in mHSPC with HRR alterations in AMPLITUDE. Dr. Attard’s key message was to systematically test for BRCA/HRR mutations and then deploy PARP inhibitors selectively, ensuring every BRCA‑positive mCRPC patient receives one and considering earlier use in HRR‑mutated mHSPC.
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| Co-PSMA Trial: Prospective Comparison of 64Cu-SAR-Bis-PSMA Versus 68Ga PSMA-11 PET CT for Prostate Cancer Detection in Patients with Biochemical Recurrence After Radical Prostatectomy
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| Louise Emmett, MD, MBChB, FRACP, FAANMS
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| In men with low‑PSA biochemical recurrence after prostatectomy, 64Cu‑SAR‑bis‑PSMA PET/CT detected prostate cancer far more often than 68Ga‑PSMA‑11 (78% vs 36% of patients; ~2.5× more lesions per patient) and showed higher true‑positive and lower false‑negative rates. This greater sensitivity and reader confidence translated into a change in planned management in 44% of patients, often escalating from surveillance to salvage radiotherapy.
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| Validation of the EAU Favorable and Unfavorable Intermediate-Risk Prognostic Groups for Predicting Biochemical Recurrence After Radical Prostatectomy in Contemporary Prostate Cancer Patients: The Added Value of MRI-Features
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| Michele Brancaccio, MD
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| This single‑center study showed that adding MRI features (stage, index lesion size, targeted‑biopsy ISUP, PSA) to the EAU intermediate‑risk stratification reclassified about one‑third of men undergoing radical prostatectomy and improved prediction of biochemical recurrence. The MRI‑integrated model yielded higher 2‑ and 4‑year BCR‑free survival separation between favorable and unfavorable groups and a better C‑index, supporting MRI‑enhanced grouping to refine candidate selection for conservative versus more aggressive management.
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