EAU 2018: Survival Analyses of Patients with Metastatic Renal Cancer Treated with Targeted Therapy With or Without Cytoreductive Nephrectomy
Copenhagen, Denmark (UroToday.com) In the cytokine era (1992-2005) addition of cytoreductive nephrectomy (CN) to cytokine therapy improved median survival from 7.8 months to 3.6 months in patients with metastatic renal cell cancer (mRCC). [1,2] The treatment for Mrcc patients has changed drastically during recent years (Figure 1). Two recent trials attempted to analyze the added benefit of CN to standard treatment of Mrcc patients. These include the CARMENA study that had serious design issues and was closed after recruiting 456 patients, and the SURTIME study, that recruited 99 patients so far, and was negative for progression free survival (PFS).
ESOU18: Open vs Robotic Surgery for Locally Advanced Prostate Cancer: Oncological and Functional Outcomes
Amsterdam, The Netherlands (UroToday.com) In the current era most prostate cancers (PC) are diagnosed at an early stage, due to the introduction of PSA-based screening. However, up to 10% of newly diagnosed PCs still present with locally advanced features, suggestive of a potentially lethal disease. To date there is no definitive consensus on the definition of locally advanced PC. Patients with locally advanced PC were historically addressed to systemic therapies, namely hormonal therapy, until recent studies demonstrated that surgery alone, or in combination with additional treatments such as radiotherapy (RT) and androgen deprivation therapy (ADT) might represent oncologically safe options, achieving high 5-yr cancer-specific survival (CSS) rates. Recent investigations have shown that robotic surgery (RARP) represents a safe and effective procedure even in the setting of these patients.
ESOU18: Radiotherapy Treatment for Oligometastatic Prostate Cancer Disease
Amsterdam, The Netherlands (UroToday.com) Prostate cancer (PC), with an estimated 1.1 million new cases globally, is the second most common cancer among men, with an estimated death of over 300,000 deaths annually. Novel imaging modalities enabled us to better diagnose patients with a limited number of metastases, after they underwent primary curative treatment. This is called the oligometastatic state which is manifested by harboring limited metastatic disease . The improvements in therapeutic techniques have changed clinical practice, allowing for a local treatment (such as surgery or radiotherapy) either with or without systemic approach for this unique state. Obviously, the distribution and extent of metastases affect the prognosis of oligometastatic castration-sensitive PC. Intuitively, patients with low-volume or oligometastatic disease have improved survival compared with those with high-volume metastases or a widely disseminated metastatic cancer .
ESOU18: The Role of Neoadjuvant and Adjuvant Therapy in Kidney Cancer
Amsterdam, The Netherlands (UroToday.com) More than 200,000 people worldwide are diagnosed with renal-cell carcinoma (RCC) each year, and almost one third of them will die from metastatic disease. Although 5-year survival rate for metastatic disease has increased, it still remains low (8-10%). Nephrectomy can be curative for the majority of patients presenting with localized disease but nearly 40% of patients initially diagnosed with stages II and III, will eventually relapse. Therefore, development of an effective adjuvant treatment for patients in high-risk for relapse following nephrectomy is mandated.
ESOU18: Cytoreductive Nephrectomy for Metastatic RCC in the Targeted Therapy Era
Amsterdam, The Netherlands (UroToday.com) Historically, when there was no known effective systemic therapy, cytoreductive nephrectomy (CN) in patients with metastatic renal cell carcinoma (mRCC) was usually reserved for palliation of local and systemic symptoms. With the rare exception of a few patients with solitary metastasis, in most cases, CN alone could not achieve cure, and was often associated with serious morbidity and mortality. However, with the introduction of immunotherapy, the role of CN was re-evaluated after the combined analysis of 2 randomized trials (EORTC 309471 and SWOG 89492) that examined patients with mRCC who either received IFNa alone or underwent CN followed by IFNa. These trials demonstrated improvement of median overall survival (OS) in patients who underwent CN.
ESOU18: New Diagnostic Tools for Upper Urinary Tract TCC
Amsterdam, The Netherlands (UroToday.com) The management of upper tract urinary cancer (UTUC) has dramatically changed over the last two decades, thanks to technological advances and the better understanding of its biological process. Kidney Sparing Surgery (KSS), including the endourological approach and distal ureterectomy, were traditionally reserved for patients with contraindications to radical nephro-ureterectomy (RNU), such as patients with a solitary kidney, bilateral tumors, and chronic kidney disease . Recently, the European Association of Urology (EAU) Guidelines  on UTUC has recommended conservative management of low risk tumors, including:
ESOU18: Complications of TURBT
Amsterdam, The Netherlands (UroToday.com) Transurethral resection of bladder tumor (TURBT) followed by pathologic examination of the obtained specimen, is an essential step in the treatment of non-muscle invasive bladder cancer (NMIBC). It is imperative that the resection be complete, include the muscle layer, and if needed, a second look resection should be performed.