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.
EAU 2018: Latest in Medical Treatment - Renal Cell Cancer
Copenhagen, Denmark (UroToday.com) Dr. Bedke gave an overview of the latest advancements in renal cell carcinoma (RCC). He discussed on the topics of cytoreductive nephrectomy (CN), adjuvant therapy (AT) and changes in 1st line therapy for advanced metastatic RCC.
EAU 2018: Analysis shows influential US prostate study not representative of real-world patients
Truckee, CA (UroToday.com) An analysis of 3 US cancer databases has shown that a major US study comparing surgery with observation in early prostate cancer patients, the PIVOT study, used patients which didn’t properly reflect the average US patient. Researchers found that patients in the PIVOT trial were between 3 and 8 times more likely to die than real-world patients. This may call into question the conclusions of the study, which are now being implemented in the US and worldwide. It was presented at the European Association of Urology congress (EAU18) in Copenhagen on 17 March, following publication as a letter in the peer-reviewed journal, European Urology1.
EAU 2018: Hormone-Naive Prostate Cancer
Copenhagen, Denmark (UroToday.com) Dr. Joniau gave an overview of hormone-naïve prostate cancer (HNPC). Approximately 5% of the screened population present with de novo metastatic prostate cancer. This represents 1/3 of the prostate cancer (PC) death in the USA each year. The remaining 2/3 of patients relapse after prior localized therapy. They undergo rapid progression to metastasis, with transformation of HSPC to castrate resistant prostate cancer (CRPC), and then to death. The median time from radical prostatectomy to PSA failure is 24 months (12-44). The median time from PSA failure to metastasis is 32 months (2-129), and finally the median time from metastasis to PC specific mortality is 82 months (7-181). Overall, from PC relapse to PC specific death the median time is 132 months (12-204).
EAU 2018: Highlights from ASCO-GU 2018
Copenhagen, Denmark (UroToday.com) Dr. Nguyen gave a talk summarizing the recent GU-ASCO 2018 meeting which took place in San-Francisco, USA, earlier this year.
EAU 2018: Castration Resistant Prostate Cancer
Copenhagen, Denmark (UroToday.com) Dr. Evans gave an overview of the hottest and latest news in the medical treatment of castrate resistant prostate cancer (CRPC). In metastatic CPRC (MCRPC), plasma circulating tumor DNA (ctDNA) has emerged as a tool to sample the tumor genome. Up until recently, no systematic comparisons of matched liquid and solid biopsies were performed to enable ctDNA profiling to replace direct tissue sampling.
EAU 2018: Urothelial Cancer – A Year in Highlights
Copenhagen, Denmark (UroToday.com) Dr. Powles gave an overview of the recent highlights and advances in the treatment of urothelial cancer. Immune checkpoint inhibitors (ICI) are the biggest advancement in urothelial cancer and the licensed ICI in metastatic urothelial cancer (MUC) are shown in figure 1.
EAU 2018: Clinicopathologic Factors Linked to Intravesical Recurrence after Radical Nephroureterectomy to Treat Upper Tract Urothelial Carcinoma
Copenhagen, Denmark (UroToday.com) Dr. Seisen proided a talk which focused on the clinicopathology factors linked to intravesical recurrence (IVR) following radical nephroureterectomy (RNU) to treat upper tract urothelial carcinoma. His talk was primarily based on the recent systematic review that he spearheaded (Seisen et al, European Urology, 2014). This has since been translated into the guidelines for the EAU.
EAU 2018: Can We Rely on Urinary Markers?
Copenhagen, Denmark (UroToday.com) Dr. Shariat was tasked with addressing the role of urinary markers for UTUC. He provided a summary of the current landscape in his presentation.
EAU 2018: Instillations in The Upper Tract: Which Technique?
Copenhagen, Denmark (UroToday.com) Dr. Seiler presented a summary of upper tract instillations and a discussion of the best method to utilize.
EAU 2018: Challenges in Prevention of Bladder Recurrence
Copenhagen, Denmark (UroToday.com) Dr. Baard presented a talk on bladder recurrence and how to prevent it in patients with upper tract urothelial cancer (UTUC). UTUC and bladder involvement:
- 2-6% bilateral disease
- 17% have concurrent bladder cancer
- 22-47% develop intravesical recurrence (IVR) following radical nephroureterectomy (RNU)
EAU 2018: Now or Never - Realizing the Promise of Precision Oncology for Urothelial Carcinoma
Copenhagen, Denmark (UroToday.com) Dr. Black gave a talk on the promise of precision oncology for urothelial carcinoma. Precision oncology allows to personalize treatment for patients and improve their outcomes. The precision oncology workflow is described in Figure 1, starting from tissue biopsy, and going through biomarkers, target identification, validation, drug selection, and monitoring for relapse.
EAU 2018: Does New Molecular Subtyping in Urothelial Cancer Add to Tumor, Nodes and Metastasis
Copenhagen, Denmark (UroToday.com) Dr. Comperat, gave an overview of the potential benefit of adding molecular subtyping to standard pathological analysis.
The gold standard of grading urothelial cancer is pathology which provides grading information, including differentiation and extension of the tumor. Pathology establishes treatment decisions. By using the TNM staging system we can classify carcinomas, helps us decide on management and decide whether we should include patients to clinical trials.
EAU 2018: Urogenital Tuberculosis: The Cause Of Ineffective Antibacterial Therapy For Urinary Tract Infections
Copenhagen, Denmark (UroToday.com) Dr. Kulchavenya, a clinical urologist from the Novosibirsk Research TB Institute, Novosibirsk Medical University, Dept. of Urology, presented on antibiotic resistance and bacterial strain similarities found in those diagnosed with a long history of urinary tract infection (UTI) and suspicious for urogenital tuberculosis (UGBT). UGTB has no specific symptoms, therefore there are currently no screening methods for early detection. However, UTIs are considered first line for differential diagnosis with UGTB.