EAU 2018: Precision Medicine in Renal Cell Cancer, Can We Select The Treatment?

Copenhagen, Denmark (UroToday.com) Dr. Alessandro Volpe provided a discussion on precision medicine for patients with renal cell cancer. Precision medicine is a medical model that proposes the customization of healthcare with medical decisions, treatment and practices tailored to the individual patient. Precision medicine, specifically in patients with high risk/advanced/metastatic RCC, includes (i) selection of the optimal targeted/immunotherapy, (ii) indications for adjuvant therapy after radical nephrectomy, and (iii) indications for cytoreductive nephrectomy in the setting of metastatic RCC. Precision medicine, specifically in patients with localized RCC, includes (i) indications for nephron-sparing surgery in larger tumors (T1b-T2), (ii) indications for lymph node dissection in high-risk disease, and (iii) indications for non-surgical management in select patients. 

EAU 2018: Molecular Heterogeneity Between Primary Tumors and Metastases in Renal Cell Cancer

Copenhagen, Denmark (UroToday.com) Dr. Kerstin Junker from Germany discussed the molecular heterogeneity between primary tumors and metastases. According to Dr. Junker there are three types of tumor heterogeneity, including (i) intertumor heterogeneity, (ii) intratumor heterogeneity, and (iii) heterogeneity between primary tumors and metastases. Understanding the heterogeneity of metastatic disease allows selection of therapy targets and prediction of therapy responses. 

EAU 2018: Molecular and Histopathological Heterogeneity in Muscle-Invasive Bladder Cancer

Copenhagen, Denmark (UroToday.com) Dr. Antonio Lopez-Beltran from Spain gave a talk on molecular and histopathological heterogeneity in muscle invasive bladder cancer (MIBC). Dr. Lopez-Beltran started by highlighting that urothelial carcinoma has two morphologic and molecular phenotypes: non-muscle invasive bladder cancer (NMIBC; 70-80%) and MIBC (20-30%). 

EAU 2018: The Critically Ill Patient with Locally Advanced Bladder Cancer – Ureterocutaneostomy? YES

Copenhagen, Denmark (UroToday.com) Dr. Armin Pycha from Bolzano, Italy provided the “yes” argument for ureterocutaneostomy in critically ill patients with locally advanced bladder cancer. 

EAU 2018: The Critically Ill Patient with Locally Advanced Bladder Cancer – Ureterocutaneostomy? NO

Copenhagen, Denmark (UroToday.com) Dr. Siemer from Germany provided the rebuttal to Dr. Pycha’s “yes” for ureterocutaneostomy in the critically ill patients with locally advanced bladder cancer. As Dr. Siemer notes, when treating the critically ill patient there is a balance between survival and quality of life/potential complications. 

EAU 2018: Optimizing Anesthesia in the Frail Patient with Bladder Cancer: What the Urologist Needs to Know

Copenhagen, Denmark (UroToday.com) Dr. Wuethrich from Switzerland succinctly summarized anesthesia concerns for frail, elderly patients with bladder cancer. Dr. Wuethrich commenced by noting that frailty is the outcome of two combined effects: the aging process and superimposed injuries (chronic disease, psychological and social stress). From a geriatrician perspective, patients with frailty should be treated if they are (i) depressed, (ii) require testosterone replacement therapy, (iii) have hypothyroidism, and (iv) require vascular disease treatment. Exercise is a cornerstone of the management of frailty at least three times per week, and elderly people who are eating poorly should be encouraged to increase their food intact including vitamins. 

EAU 2018: Results from the TRACERx Renal Study: Deterministic Routes to Tumor Progression in Clear Cell Renal Cell Carcinoma

Copenhagen, Denmark (UroToday.com) Dr. Samra Turajlic from the Francis Crick Institute in London provided initial results from the TRACERx Renal study. Dr. Turajlic opened by noting that there are a wide range of clinical phenotypes/outcomes among patients with advanced renal cell carcinoma, including (i) indolent disease – oligo metastatic progression among which patients may benefit from cytoreductive nephrectomy and oligo-metastasectomy, and (ii) aggressive disease – disseminated metastases and early death among which patients do not benefit from cytoreductive nephrectomy and have a poor response to therapy. There are three important clinical dilemmas according to Dr. Turajlic: (i) treatment of metastatic disease, which may include surgery to defer systemic therapy, (ii) adjuvant therapy for high-risk disease, (iii) active surveillance of small renal masses.

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