On BRCA mutations

In her presentation on BRCA, medical oncologist and EMUC25 Steering Committee member Dr. Elena Castro (ES) stated that lifetime prostate cancer (PCa) risk is significantly elevated in individuals with BRCA mutations, with estimates of approximately 17% for BRCA1 carriers and up to 40% for those with BRCA2. Due to this higher risk, annual PSA screening beginning at age 40–45 is recommended for BRCA2 mutation carriers. In contrast, there is currently no clearly established screening ESMO guideline for individuals with BRCA1 mutations.

Germline BRCA2 is considered an adverse prognostic factor in PCa, while the impact of BRCA1 is less well defined. Patients with PCa who harbour BRCA1 or BRCA2 mutations benefit from close clinical monitoring. Importantly, germline BRCA1 and BRCA2 alterations sensitise tumours to PARP inhibitors.

Men with high-risk localised, locally advanced, or metastatic PCa should be offered germline genetic testing. Currently, there are no clinical characteristics to identify mutation carriers. Dr. Castro added that when a BRCA1 or BRCA2 mutation is detected in tumour tissue, germline origin should be excluded.

PRS for PCa screening

In her presentation “Polygenic risk to guide prostate cancer screening”, oncogenetics research nurse consultant Dr. Elizabeth Bancroft (GB) discussed the potential of using PRS in PCa screening.

PRS is used to estimate an individual’s genetic predisposition to developing a certain disease. However, it only provides the probability, not a prediction. A higher PRS means a higher genetic predisposition to the disease relative to others in the population, and it can be used to risk-stratify populations.

PRS is calculated by summing the effects of single nucleotide polymorphisms (SNPs), which are the most common type of genetic variation among people. There are 451 SNPs identified that are associated with PCa.

Dr. Bancroft discussed the BARCODE1 study, which evaluated the use of PRS (~130 SNPs) to identify those at the highest risk. Those participants in the top 10% were offered PSA, MRI, and prostate biopsy. The BARCODE1 study concluded that PRS found a high proportion of clinically significant PCa in men at higher genetic risk. PSA and MRI missed some significant cancers in this high-risk group.

“PRS is a one-time test using germline DNA, which is constant, unlike other tools such as PSA, which can fluctuate,” stated Dr. Bancroft.

Furthermore, the PRODICT study, which will replicate BARCODE1, was recently launched with an enriched recruitment in Black African, Black Caribbean, East Asian and South Asian populations.

Pathologist Prof. Markus Eckstein (DE), urologist Prof. Juan Gómez Rivas (ES), oncologist Dr. Pasquale Rescigno (GB), radiation oncologist Dr. Noelia Sanmamed (ES), and radiologist Prof. Harriet Thoeny (CH) spearheaded the session.

For more information, you can (re)watch the presentations via the EMUC25 Resource Centre.

The post EMUC25 examines BRCA and PRS in hereditary GU cancers session appeared first on EMUC25.

PSMAddition

Medical oncologist Prof. Scott Tagawa (US) presented the interim analysis of PSMAddition, a phase III trial of ¹⁷⁷Lu-PSMA-617 combined with androgen deprivation therapy (ADT) plus an androgen receptor pathway inhibitor (ARPI) in patients with PSMA-positive metastatic hormone-sensitive prostate cancer (mHSPC).

Dr. Tagawa: “The addition of ¹⁷⁷Lu-PSMA-617 with ADT and ARPI led to a statistically significant improvement in radiographic progression-free survival (rPFS) in patients with PSMA-positive mHSPC, compared to ADT + ARPI. This benefit was consistent across subgroups. There was a positive trend in overall survival (OS), with follow-up for mature data ongoing. The results of the PSA response, PFS, mCRPC, and symptomatic skeletal events (SSE) favoured the ¹⁷⁷Lu-PSMA-617 combination arm.”

In regard to safety, Dr. Tagawa said that findings where consistent with the known profile of ¹⁷⁷Lu-PSMA-617, with no unexpected concerns about the combination with ADT + ARPI. “Adverse events were more frequent in the ¹⁷⁷Lu-PSMA-617 combination arm, most commonly dry mouth, fatigue, and nausea. There were no clinically significant differences in time worsening in health-related quality of life.”

He concluded that the PSMAddition trial findings indicate that combining ¹⁷⁷Lu-PSMA-617 with ADT and ARPI provides a clinically meaningful benefit in patients with PSMA-positive mHSPC.

AMPLITUDE

“This trial is a good example of molecular precision medicine.” Began Dr. Gerhardt Attard (GB) in his presentation on the phase 3 AMPLITUDE trial results: niraparib + abiraterone acetate + prednisone for metastatic castration-sensitive prostate cancer (mCSPC) patients with alterations in homologous recombination repair genes.

Dr. Attard: “The AMPLITUDE trial met its primary endpoint of improved rPFS, with the likely greatest benefit of the combination treatment in patients with BRCA alterations (HR: 0.52). Improvements in rPFS were supported by a statistically significant delay in time to symptomatic progression and a trend toward improved overall survival. There was less than 5% increase in patients discontinuing treatment due to toxicity compared to the placebo.”

He also noted that treatment intensification requires careful patient selection due to the associated increase in toxicity.

He concluded that the AMPLITUDE results support early genomic testing, and niraparib + abiraterone acetate + prednisone as a new treatment option for patients with mHSPC and HRR gene alterations.

CAPItello-281

Dr. Gerhardt Attard (GB) also presented the phase III study of capivasertib + abiraterone versus placebo + abiraterone in patients with PTEN-deficient de novo mHSPC, an important advancement given that these patients typically have a poor prognosis and limited benefit from the current standard-of-care therapy.

From the results he presented, the CAPItello-281 trial met its primary objective, showing statistically significant PFS benefit with capivasertib + abiraterone versus placebo + abiraterone. “The median rPFS of capivasertib + abiraterone was 33.2 months versus the placebo + abiraterone of 25.7 months (HR: 0.81, 95% CI: 0.66-0.98; p=0.034). Consistent benefits were also observed in secondary endpoints and clinically relevant pre-defined subgroups, but overall data were immature, and further follow-up is planned”.

Dr. Attard concluded with, “Capivasertib + abiraterone represents a potential first-in-class targeted treatment for patients with PTEN-deficient mHSPC.”

EMBARK

Dr. Murilo De Almeida Luz (US) presented the overall survival (OS) results from EMBARK, a randomised phase III trial of enzalutamide (enza) or placebo + leuprolide acetate and enzalutamide monotherapy in high-risk biochemically recurrent prostate cancer (HRBCR PCa). This trial began in 2014.

According to the trial results Dr. De Almeida Luz presented, the combination of enza + leuprolide reduced the risk of death by more than 40% versus leuprolide alone in patients with HRBCR PCa, and there was no evidence of metastasis on conventional imaging.

“Enza monotherapy led to numerically lower risk of death versus leuprolide alone, although the difference did not reach statistical significance. The trial results show that significant improvements in time to first use of the new antineoplastic therapy, time to symptomatic skeletal events, and PFS further highlight the benefit of both combining enza and monotherapy. The results show no new safety signals in the long-term safety analysis.”

—–

You can watch the full presentations, including the other ‘game-changing’ trials presented (CREST, ARASAFE, PACE B+C, and POTOMAC) via webcast recordings at the EMUC25 Resource Centre.

The post The big PCa game-changers for 2025 appeared first on EMUC25.

Update on kidney cancer screening

How can we improve survival from kidney cancer? “In my opinion, we need to treat high-risk localised diseased better with drugs around the time of surgery, and critically, to detect it earlier,” said Prof. Grant Stewart (GB) while presenting results from the Yorkshire Kidney Screening Trial, as well as future research plans. The latter explored the feasibility of adding abdominal non-contrast CT to screen for kidney cancer and other abdominal pathology to the chest CT offered within lung cancer screening.”

His results illustrated that from the 4,019 who accepted the scan, 5.3% of participants were found to have serious findings involving one or more organ systems. Only 18 participants needed to be screened to detect one serious finding, showcasing the efficiency of this programme. Ninety-three to identify a suspicious renal lesion, and 402 to confirm one case of renal cancer histologically. (Stewart G et al. European Urology, May 2025)

According to Prof. Stewart, the next step is to test whether abdomen screening can stage shift disease and/or improve disease specific survival. Starting this week, this will be evaluated in a randomised trial, piloted first in the ‘live’ Lung Cancer Screening Programme – TACTICAL1 (Targeted Abdominal CT in Conjunction with Lung screen). This feasibility study adds a non-contrast abdominal CT scan to the Targeted Lung Health Check thorax CT in high lung cancer risk ever-smokers aged 55-60 years.

Rehabilitating PSA screening in North America

According to Prof. Laurence Klotz (CA), “The US and Canadian national guidelines are a mess”, both being inconsistent, as well as outdated, with conflicting interests between methodologists and clinicians. In his lecture, he shared details of his work with the ‘Canadian Coalition for Responsible Health Care Guidelines’, a group formed in 2022 to improve guidelines in Canada.

As a result, the Canadian Task Force responsible for writing the guidelines was ‘paused’ by the Ministry of Health this year, with plans to move towards a more agile ‘living guidelines’ approach. Prof. Klotz stressed the importance of involving colleagues from other specialities to ensure expert representation on guidelines panels.

In his opinion, future PCa screening considerations include how to use PSA optimally – specifically, what upper threshold should prompt further testing and what lower threshold to stop testing, including intervals. He recommends a national screening programme for men at risk, restricting testing to only men who will benefit. The outcome will result in less overdiagnosis and morbidity from treatment, as well as fewer biopsies and missed significant cancers.

Whole body-MRI screening for healthy people: A tool for the future?

“Without the right clinical question, even the best technology is useless,” stated Prof. Konrad Stock (DE) as he opened the discussion on the innovative use of whole body MRI (WB-MRI) as a screening tool in healthy people. He emphasised that different cancer types need different strategies for effective detection.

Prof. Giuseppe Petralia (IT) presented on the pros and cons of using WB-MRI as a cancer screening tool in healthy individuals, detailing both its clinical effectiveness and the ethical considerations. He cited findings from his paper on “Oncology relevant findings reporting and data systems (ONCO-RAD): Guidelines for the acquisition, interpretation, and reporting of whole-body MRI for cancer screening.

According to Prof. Petralia, there is no evidence of its cost-effectiveness, raising questions about who pays for it, and who ultimately benefits – such as high-risk groups for cancers that do not currently have screening programmes (e.g., urinary bladder, kidney, pancreas, liver, non-Hodgkin Lymphoma [NHL]).

“The survival benefit of WB-MRI has not yet been measured, but its use is increasing. Studies report up to 99% abnormal findings, with cancer detected in 1-2% of cases. The main challenge is to minimise harm and avoid over-investigation for the majority, while ensuring optimal management for those with confirmed cancer through expert, multi-organ evaluations”.

Prof. Petralia also elaborated on ethical concerns, particularly around the growing direct-to-consumer WB-MRI market, which bypass traditional physician gatekeeping. Their marketing often emphasises potential benefits and minimises limitations. “It is an unregulated industry with no centralised registry or data on companies operating in this space.” He also stated that there are concerns around a truly informed consent from patients.

You can watch the full presentation at the EMUC25 Resource Centre

The post The future of finding cancer: Detecting earlier appeared first on EMUC25.

Leading voices such as radiation oncologist and one of the session chairs, Prof. Thomas Zilli (CH), together with some of the presenters epidemiologist Prof. Monique Roobol (NL), medical oncologist Prof. Yüksel Ürün (TR), and urologist Prof. Veeru Kasivisvanathan (GB) will provide crucial insights during Plenary Session 1: Innovating for a Sustainable Future in Genito-Urinary Cancer Care: The Road to 2050.

Why the focus on sustainability?

“This session was inspired by a growing awareness that sustainability in healthcare must extend beyond environmental concerns to include economic viability, resource optimisation, and equitable patient access—especially in a field as complex and evolving as GU cancer care where technology and new systemic therapies are growing exponentially,” said Prof. Zilli.

From the perspective of radiation oncology, he noted both the progress and the tension: “We’ve seen remarkable advances in the last decades in imaging, planning, and delivery, but these innovations often come with increased costs, energy demands, and disparities in access. As we look toward 2050, how can radiation oncology continue to evolve in a way that is environmentally responsible, economically feasible, and equitable across diverse patient populations?”

Provoking a mindset shift

Prof. Zilli emphasised that Plenary Session 1 is designed to provide both inspiration and practical tools. “We want to provoke a mindset shift where sustainability can become an integrating part and principle of clinical decision-making, policy planning, and innovation. In addition, we also want delegates to leave with actionable insights such as sustainable technology adoption, frameworks for reducing the environmental footprint of care, or collaborative strategies to address disparities in access.”

The examples he provided included hypofractionation in radiotherapy, artificial intelligence (AI)-driven planning, and cloud-based systems to improve access in underserved regions.

New frontiers

Prof. Zilli highlighted one of the most provocative themes of the session: the intersection of precision medicine and sustainability to provide personalised treatment by means of imaging, biomarkers, AI-driven tools; prevent overtreatment; and reduce waste and costs.

The session will also address ethical and global questions, from equitable access to cutting-edge treatments to the environmental implications of diagnostic and therapeutic pathways.

A sneak peek and dispelling myths

In her lecture, Prostate cancer screening at its best, Prof. Roobol will discuss how prostate cancer screening has evolved from an era of evidence-gathering through randomised trials to one focused on applying these results in healthcare, as Europe prepares to address a disease affecting so many men.

Prof. Roobol also revealed a sustainability myth in her field: “A common myth is that organised prostate cancer screening does not reduce unnecessary healthcare costs, when in reality, it is the only way to sustainably reduce the burden of this disease.”

“In genitourinary cancers, sustainability means integrating evidence-based innovations with rational use of resources,” said Prof. Ürün. In his lecture, Sustainable treatments: Medical oncology, he will provide strategies to optimise treatment duration; select therapies using validated biomarkers; and design sequencing that preserves future options.

He also addressed misconceptions: “Many assume that sustainability conflicts with optimal cancer care, but the opposite is often true. Avoiding low-value interventions, limiting overtreatment, and tailoring intensity to disease biology can improve outcomes and reduce toxicity. From my perspective, sustainable oncology is not a compromise, it is the foundation of long-term quality care.”

“My lecture, Sustainable diagnosis and staging, will discuss delivering the right investigations to the right patient at the right time, whilst minimising harm, cost, and environmental impact. With an ageing population, a surge anticipated in prostate cancer cases, and the introduction of novel imaging techniques, this is an increasingly important topic,” stated Prof. Kasivisvanathan.

When asked about sustainability myths in urology, he said, “A common misconception is that sustainability is not the urologist’s direct problem. However, I believe that urologists need to play an active role in ensuring sustainable care, as we are the ones making key decisions about who to biopsy, which imaging to order, and how to stage patients, which in turn influence the sustainability of the services that we provide.”

Not less, but smarter

Whether in screening, diagnosis, treatment, or long-term planning, the experts highlighted how sustainable practices can reduce waste, lower costs, expand access, and ultimately improve outcomes.

As Prof. Zilli put it, “The goal is to equip delegates not only to think differently but to act decisively in shaping a more sustainable future for GU cancer care.”

EMUC25 awaits you

The congress scientific programme blends the latest developments, actionable insights, and hands-on activities—all designed to make a real impact on your clinical practice and patient care. Join us at EMUC25 and register here.

Have insights, research, or innovations to share as late-breaking abstracts? Be heard, be seen, make an impact—submit your abstract before 1 October 2025 and contribute to the dialogue on optimal GU cancer care.

The post No compromises: GU-cancer care can be effective, equitable, accessible, and sustainable by 2050 appeared first on EMUC25.

PSMAfore and SPLASH

Dr. Riccardo Mei (IT) shared the results of the PSMAfore and SPLASH studies in his presentation ‘Lu-PSMA radioligand therapy in pre-taxane mCRPC patients’.  He stated that both the trials enrolled patients with androgen receptor pathway inhibitor (ARPI) pre-treated, progressive metastatic castration-resistant prostate cancer (mCRPC) with evidence of PSMA-avid PET. The radionuclide dose was significantly higher in the PSMAfore trial where patients received 7.4 GBq every six weeks for up to six cycles, versus 6.8 GBq every eight weeks for up to four cycles in SPLASH.

Dr. Mei explained that both trials met their primary endpoint of a radiographic progression-free survival benefit, although the magnitude of benefit was greater in PSMAfore (HRs: 0.43 versus 0.71 for SPLASH). Both trials demonstrated a health-related quality of life benefit for Lu PSMA. “PSMA RLT reduced the risk of radiographic progression versus an ARPI switch in taxane-naive patients. Lower dose and longer intervals seem to reduce response with only some reduction in the incidence of side effects, particularly dry mouth and anaemia.”

In Dr. Mei’s opinion, there are many questions yet to be answered about the timing of treatment, optimal dosing, number of cycles of Lu-PSMA, combined/tailored treatment, new isotopes (alpha emitters, auger emitters), as well as therapy selection when considering tumour burden, number of treatments, aggressive/indolent disease, genetic profile etc.

PEACE-3

“ENZA (enzalutamide) + Ra223 (radium-223 dichloride) is the first ARPI combination to show statistically significant improvement in both radiographic progression-free survival (HR 0.69) and overall survival in bone metastatic castration-resistant prostate cancer”, stated medical oncologist Dr. Fabio Turco (CH) in his presentation where he shared the recent results of the PEACE-3 trial.

PEACE-3 is a randomised, open-label phase III trial investigating the combination of radium-233 and enzalutamide in asymptomatic or mildly symptomatic patients with bone mCRPC. Dr. Turco defined radium-223 as an alpha-particle-emitting calcium mimetic that selectively targets bone metastases and induces double-stranded DNA-breaks. He explained that the study design comprised enrolment of 426 patients across 12 counties from 2015 to 2023. Eligible patients who had castration-resistant PCa with bone metastases were asymptomatic or mildly symptomatic, and had not received prior treatment with enzalutamide, apalutamide, darolutamide, or radium-223.

According to Dr. Turco, the addition of Ra223 to enzalutamide was associated with significant improvements in the primary endpoint of radiographic progression-free survival (median: 19.4 versus 16.4 months; HR: 0.69) and there was an overall survival benefit of 42.3 months for ENZA + Ra223 versus 35 months for enzalutamide monotherapy.

“The trial results support the combination of ENZA + Ra223 (plus a bone density protecting agent) as a potential new first line mCRPC treatment option for patients with prostate cancer and bone metastases who have not received a prior-androgen-receptor pathway inhibitor”.

GETUG-AFU 18

Radiation oncologist Prof. Christophe Hennequin (FR) presented on the GETUG (French Genito-Urinary Tumour Group) 18 trial evaluating the impact of radiotherapy therapy dose escalation (80 versus 70Gy) in high-risk prostate cancer patients receiving long-term androgen deprivation therapy (ADT). Prof. Hennequin stated that 505 patients from 25 French centres were included in the trial. Over a median follow-up of 9.5 years, the biochemical or clinical progression-free survival was significantly improved in the dose-escalated radiotherapy arm compared with conventional radiotherapy arm (HR 0.56). There were also significant differences in prostate cancer-specific survival (HR 0.48) and improved overall survival (HR 0.61).

In his closing summary of the trial results, Dr. Hennequin concluded that even in the case of long-term ADT, higher dose radiotherapy (80 Gy) improved progression-free survival, prostate cancer survival and overall survival among patients with high-risk prostate cancer. “These efficacy results were achieved with no increase in toxicity. High dose radiotherapy with long-term ADT is a new standard of care in the management of high risk localised prostate cancer.”

You can watch the full presentations via webcast recordings at the EMUC24 Resource Centre.

The post What were the big game changers for 2024? appeared first on EMUC25.

What is EU-ProPER?

EU-ProPER is a study that looks into the effects of PCa on the relationship, intimacy, sexuality, and social life. Available in 17 languages, a 20-minute online survey comprised of 80 questions and the SF-12v2® Health Survey was distributed in the EUomo member network. The survey collected 1,135 valid responses from 9 October to 31 December 2023.

The findings

Out of all the respondents, 46% reported that PCa has influenced their relationships. About 48% observed that their partners are not the same after PCa treatment(s). Around 32% reported effects on their social and family life and 19% reported reduced participation in own activities.

Sixty-seven percent disclosed a loss in intimacy. Only 27% of PCa partners are satisfied with their sex life. Around 73% declared that their sex life was better before the PCa diagnosis. About 32% reported frustration from their sex life. On communicating to their partners how they feel about their sex life, 29% disclosed they find it difficult.

Around 39% reported that incontinence is still taboo and has implications on their sex and social life (i.e. “Nobody apart from me is aware of my partner’s incontinence”). About 16% reported a need for mental support from a mental health professional.

Sixty-five percent were involved in the decision-making process regarding treatment. However, 16% were not aware of the consequences of the PCa treatment(s). About 20% received information about sexuality from healthcare providers (HCPs) and 52% searched for the information themselves.

The post Stepping into their shoes: EU-ProPER studies partners of PCa patients appeared first on EMUC25.

Dr. Papanikolaou: “The main objectives of ProCancer-I is to deliver a PCa AI platform featuring a unique collection of PCa mpMRI images worldwide, in terms of data quantity, quality and diversity. This platform should produce novel AI clinical tools based on a three-stage ensemble modelling process for advancing characterisation of PCa lesions, assessment of the metastatic potential, and early detection of disease recurrence. Ultimately, the goal of this project is to contribute in the increase of the trust in PCa AI tools by introducing AI model interpretability functionality. We have been collecting data over 4 years, resulting in one of the biggest imaging databases for PCa with 12,816 patients and total images of 8,425,386, called ProstateNET.”

According to Dr. Papanikolaou, MRI issues include diagnostic delay, overdiagnosis, high interobserver variability (large differences between expert and non-expert radiologists), long exam times, and lack of predictivity. To address these issues, he outlines areas of the population screening pathway where AI could be a useful tool in the future. “The expectation of AI is for it to be more accurate (further increase in sensitivity and specificity), reduce reporting times and reduce unnecessary biopsies.”

Dr. Papanikolaou addressed several challenges with AI in the screening versus diagnosis set up, but also potential solutions. “A fundamental requirement in AI and machine learning is that someone should always use a model with data that are similar to the training dataset, which makes out-of-the-box use of diagnostic models to the general population not feasible. Not only are the imaging characteristics between the screening and the diagnostic scenario different, but most importantly, the prevalence of clinically significant disease is much lower in the screening population, as expected.”

“The simple way to solve this problem would be to collect data from the normal population and train new models from scratch, but given the very low prevalence of significant diseases, that would take a long time. A more sophisticated approach is transfer learning, where knowledge from one domain is adapted and transferred to another domain. Someone could consider the diagnostic models as the backbone of new screening models where, with fine-tuning, they can adapt to screening data. The latter scenario would need only a small portion of the entire dataset to be collected, which is more feasible than training from scratch.”

You can watch the full presentation at the EMUC24 Resource Centre.

The post Integrating AI for PCa screening and diagnosis: ProCancer-I appeared first on EMUC25.

Urologist Ms. Maxine Tran (GB) delivered a presentation on ‘Nephron Sparing Treatment (NEST) for small renal masses’, a feasibility study of a cohort embedded randomised controlled trial comparing nephron sparing treatment for small renal masses.

Ms. Tran stated that feasibility of the trial was demonstrated, intervention was acceptable (85%), there were fewer complications, less reduction in renal function, reduced hospital stays, decrease in costs, and intervention showed equivalent cancer control.

In his presentation, ‘Update on PSMA targeting’, Dr. Andrea Farolfi (IT) shared results and comparisons of the PSMAfore (phase 3) and ENZA-p (phase 2) trials.

Dr. Farolfi: “PSMA-targeted radioligand therapy (RLT) is gaining momentum globally and there are new trials coming. Lutetium PSMA is quite active in this taxane-naïve metastatic castration-resistant prostate cancer (CRPC) space, and was extremely well tolerated. We have a new therapy that eventually, when regulators approve, will be available for patients in this space.”

“We do not need to sacrifice the quality of life (QoL) for oncological benefits. Enzalutamide combination and enzalutamide monotherapy do not negatively affect health-related quality of life (HRQoL),” stated Prof. Stephen Freedland (US) in his presentation on the EMBARK trial.

According to Prof. Freedland, in patients with high-risk biochemical recurrence (BCR) compared with leuprolide acetate, the enzalutamide combination demonstrated a statistically significant and clinically meaningful improvement in metastasis-free survival (MFS) (HR 0.42; 95% CI, 0.30-61; P<0.0001).

“Enzalutamide monotherapy also demonstrated statistically significant and clinically meaningful improvements in MFS (HR 0.63; 95%, CI 0.46-0.87; P=0.0049), time to PSA progression, and time to the first new antineoplastic therapy. No new safety signals observed to date with enzalutamide treatment”.

“Enzalutamide in combination with androgen deprivation therapy (ADT), if approved in this setting, has the potential to become a new standard of care for patients with high-risk BCR (biochemical recurrence).”

In her lecture, ‘Update on TALAPRO and PROpel’, medical oncologist Dr. Friederike Schlürmann (FR) shared a summary of game-changing improvements in overall survival (OS) over the years with the addition of PARPi to ADT+ARSI (androgen receptor signalling agent) in metastatic castration-resistant prostate cancer (mCRPC).

Dr. Schlürmann: “The TALAPRO and PROpel trials show clinical benefit beyond HRRm, and all trials support activity for PARPi + NHA in HRRm/BRCAm mCRPC. There must be caution with cross-trial comparison and differences in the study designs, populations and dosing schedules between trials may provide considerations for the differences seen between trials.”

On the topic of testing, Dr. Schlürmann stressed that somatic testing for BRCA1/2 has to become the standard of care in PCa.

Great news for BCa patients

Prof. Tom Powles (GB) was beamed in from America to deliver a presentation on the EVO-302/KEYNOTE-A39 trial. “This is the first time that platinum-based chemotherapy has been surpassed in OS in patients with previously untreated locally advanced/metastatic urothelial carcinoma (la/mUC). The overall results support enfortumab vedotin plus pembrolizumab (EV+P) as a potential new standard of care for 1L la/mUC.”

According to Prof. Powles, EV+P showed statistically significant and clinically meaningful improvement in efficacy over chemotherapy with a progression-free survival (PFS) of HR 0.45 and OS was 0.47%. Median PFS (mPFS) and median OS (mOS) were nearly doubled in the EV+P arm compared with chemotherapy. The benefit in prespecified subgroups and stratification factors were consistent with the overall population. The safety profile aligned with expectations and no new safety signals observed. EV treatment-related adverse events of note were skin reactions, peripheral neuropathy and sensory events.

Dr. Yohann Loriot (FR) presented on the THOR trial, stating that in the trial that erdafitnib significantly extended the OS in patients with advanced/mUC with FGFRalt after prior treatment with anti-PD-(1), with a mOS of 1 year.

According to Dr. Loriot, erdafitnib provided a 36% reduction in risk of death compared to chemotherapy, the OS benefit of erdafitnib was consistent across the relevant subgroups, and it offered significantly longer PFS and greater objective response rate (ORR) compared to chemotherapy.

Dr. Loriot: “This phase 3 THOR study supports the clinical efficacy of erdafitnib as the standard of care option for patients with mUC with FGFRalt after anti-PD-(L) 1 treatment, and the OS benefit of erdafitnib in patients with mUC with FGFRalt supports molecular testing for FGFRalt in all patients with mUC”.

You can watch a webcast recording of the full presentations on the EMUC23 Resource Centre.

The post 2023 ends with big game changers for GU cancers appeared first on EMUC25.

Mr. Leigh: “We will consider three cases in this session, using the format of an M&M Meeting. We will try to be candid and fair, looking for ways to improve practice. We asked our presenters to choose cases from which lessons may be learned. None of the cases have obvious negligence, but all present learning opportunities.”

A quality audit – measuring outcomes and complications

Asst. Prof. Giorgio Gandaglia (IT) presented a prostate cancer case from his institution for review.

• A 72-year-old male
• BMI 23
• Type 2 DM
• Medication: metformin
• PSA 4.3 ng/ml
• CT scan:  prostate x 1.5, suspicious module right side, prostate 40ml; adenoma 20 ml, prostate biopsy showed adenocarcinoma of the              prostate, FF2, 5/15 positive cores, bone scan was negative, abdominal TC: bilateral renal cysts

The patient underwent a robot-assisted radical prostatectomy. He was discharged on day three postoperative, but on day six, he was admitted to the ER with haematuria and fever, a malfunctioning of the bladder catheter. He was re-admitted to the ER on day 30 with the same complication.

Is it important to chase complications after robotic surgery? According to Asst. Prof. Gandaglia, a wide heterogeneity exists in the rate of postoperative complications after robotic surgery. Although, there has been an exponential increase in the papers using the Clavien-Dondo system over the last few years, only 65% of urologic manuscripts adopt the score correctly.

Asst. Prof. Gandaglia shared details on how his institution learnt from this experience. “The first phase of our prospective study consisted of an audit and feedback process, where the most frequent complications observed in our series were prospectively collected, and in January 2018 an appraisal was done. The most common complication was anastomotic leaks (6.7%). Changes in the surgical technique were proposed to improve outcomes after collegial discussion and review of the surgical videos were recorded during the audit and feedback phase.”

According to Asst. Prof. Gandaglia, the outcome was the introduction of a novel technique for vesico-urethral anastomosis. “The awareness of postoperative outcomes led to the implementation of changes in the surgical techniques that significantly reduced the risk of specific postoperative complications.”

Risks of radical cystectomy

Dr. Carmen Mir (ES) presented a bladder cancer case and how the outcome led to learning and making changes to limit the chance of surgical site infections. She stated that reviewing the risks of radical cystectomy need to cover interoperative, in-hospital, early recovery, and long term. Changes implemented in her institution from this case included fragility assessment for patients over 70 years old, redoes antibiotic therapy and the use of chlorhexidine for prepping. “We also change the surgical instrument set at closure, use running 5mm 1-0 resorbable elastic monofilament, and saline for wound clean up before skin closure”.

A take-home message from Dr. Mir was “Look at your own institution and see what is working and what’s not working. There are a lot of small things that could make a difference to the outcome”.

A need for anticoagulation therapy (ACT) pre-operatively?

Prof. Faiz Mumtas (GB) presented a complicated kidney cancer case of an 80-year-old male with a high BMI of 38 and a visible haematuria with a normal MSU, blood profile and cystoscopy. He had a permanent pacemaker for asymptomatic bradycardia.

According to Prof. Mumtas, in the patients initial CT scan he had a level 2 Pt3b caval tumour. “His staging CT and MRV (Magnetic Resonance Venography) got delayed whilst waiting for a cystoscopy and so he represented with a saddle pulmonary embolism (PE) with an extension in the caval tumour height. With extensive PE we did anticoagulated therapeutically with no significant haemodynamic improvement. Surgery was delayed due to recurrent PE. This further delay led to the growth of the tumour size and it now approached the level of the hepatic veins making it level 3. This indicated a significant progression.”

Prof. Mumtas stated that a cardiac bypass had to be performed at a different institution. He concluded his presentations with the learning points from this case:

1. Anticoagulation in the presence of high-risk factors – recurrent VTE (venous thromboembolism) and bland tumours
2. Concerning up-to-date imaging, Prof. Mumtas suggests no more than a couple of days before surgery.
3. Further multicentre studies are needed to explore the role of pre-operative anticoagulation and neoadjuvant systemic treatments.
4. Operating on level 3 tumours only in facilities where cardiac bypass is available, is to manage patients who become haemodynamically unstable with supra-hepatic clamp.

You can watch a webcast recording of the full presentations on the EMUC23 Resource Centre.

The post “If you can’t measure it, you can’t improve it” appeared first on EMUC25.

Prof. Georg Salomon (DE) and Dr. Jochen Walz (FR) chaired the session, which also covered topics on the enhancement of access to radiotheranostics for cancer care through the Oncidium initiative, as well as the different tracers for various indications in every cancer type.

In her presentation, “Current challenges of PSMA PET/CT in prostate cancer”, Assoc. Prof. Daniela Oprea-Lager (NL) cited the EAU Guidelines on Prostate Cancer, which stated PSMA PET/CT is more accurate for staging than CT and bone scan for high-risk disease but to date, no outcome data exists to inform subsequent management.

One of the recommendations of the EAU Guidelines with a “Strong” strength rating was when using PSMA PET or whole-body MRI to increase sensitivity, be aware of the lack of outcome data of subsequent treatment changes.

Assoc. Prof. Oprea-Lager concluded, “We cannot ignore modern imaging techniques and continue re(staging) and treating disease as we did in the era of conventional imaging.” She added that clinical outcomes such as overall survival, disease recurrence, and quality of life should be proven first. Learning how to interpret modern imaging properly and how to treat patients is imperative.

View the session recap and watch the full presentations on the EMUC23 Resource Centre.

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