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 [1]. 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 [2].

ESOU18: Is Lymph Node Dissection Necessary in Prostate Cancer? The European Perspective

Amsterdam, The Netherlands (UroToday.com) According to the European perspective, there is no need to perform pelvic lymph node dissection (PLND) in low risk prostate cancer (PC) patients. In contrast, extended PLND (EPLND) (Figure 1) should be performed in all high-risk PC patients, and in intermediate risk PC if the estimated risk of positive lymph nodes (LN) exceeds 5%. Lastly, there is no role for limited PLND.

ESOU18: Is Lymph Node Dissection Necessary in Prostate Cancer? The American Perspective

Amsterdam, The Netherlands (UroToday.com) Dr. Evans gave a most interesting talk on the role of pelvic lymph node dissection (PLND) in prostate cancer PC. PLND in PC has several goals:

ESOU18: Reappraisal of Neoadjuvant Therapy for High and Very High-risk Prostate Cancer - Yes

Amsterdam, The Netherlands (UroToday.com) It is known that 20-35% of prostate cancer (PC) patients present with high risk disease, and 15-40% have lymph node involvement. Furthermore, 40-65% of patients experience biochemical recurrence (BCR) within 5 years of local treatment. Lastly, prostate cancer specific mortality (CSM) is almost 20% at 15 years.

ESOU18: Reappraisal of Neoadjuvant Therapy for High and Very High-risk Prostate Cancer - No

Amsterdam, The Netherlands (UroToday.com) Studies have attempted to show a benefit with androgen deprivation therapy (ADT) given in the neoadjuvant setting before radical prostatectomy (RP). The results have shown a significant decrease in the rate of positive surgical margins, but no difference in 5 year disease free survival. 

ESOU18: Salvage Radical Prostatectomy – Robotic

Amsterdam, The Netherlands (UroToday.com) The median time from biochemical recurrence (BCR) in prostate cancer (PC) to development of metastasis is between 3 and 7 years. After radiotherapy (RT) local recurrence rates range between 10-55%, depending on the RT dose given and whether the disease was high risk or not.  The PSA nadir can predict the risk of metastasis. An early (less than 6 months) high PSA (>2 ng/ml) predicts development of metastasis.
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