Sustainable diagnosis and staging
In his presentation “Sustainable diagnosis and staging,” Prof. Veeru Kasivisvanathan (GB) outlined key sustainability principles, including “use less” (reduce waste and minimise unnecessary consumption), “use longer” (extend the lifespan of existing products), and “use greener” (adopt more environmentally friendly alternatives).

In urothelial diagnostics, sustainability in patient selection includes optimising secondary-care referrals. From a diagnostic perspective, key measures include establishing one-stop haematuria clinics, decarbonising flexible cystoscopy (for example, avoiding sterile cystoscope drapes by placing the scope on the decontamination storage tray and omitting hospital gowns), performing flexis in the clinical setting, minimising the use of CT urograms, and implementing same-day preoperative assessment.

Regarding sustainability in prostate cancer (PCa) diagnostics, Prof. Kasivisvanathan emphasised selecting patients at the highest risk of harbouring clinically significant PCa for imaging or biopsy. He added to avoid the diagnosis of clinically significant cancer; reduce the risk of complications to patients; and to use imaging and biopsy appropriately to ensure high-quality outcomes. He also noted that optimising imaging departments—such as by switching off unused electronic devices and PACS systems—can yield substantial environmental benefits, with the latter alone capable of saving an estimated 51.2 tonnes of CO₂ annually.

On radiation therapy (RT)

Radiation oncologist Dr. David Hunt (GB) discussed hypofractionation as a sustainable alternative to standard RT during his presentation “Sustainable treatments: Radiation therapy”. Hypofractionation is when the total dose of radiation is divided into large doses, and treatments are given less often.

Dr. Hunt addressed the audience and said, “To the leaders in the room, we need you to champion high-impact change in terms of how we run, build, and deliver, and empower healthcare services. We need your voices to be loud to drive improvements within the industry where we’re making big decisions in the procurement of equipment and [to encourage] the development of more sustainable, durable, and efficient devices.”

To fellow radiation oncologists, he stated, “You can make the biggest difference today. Adopt the evidence-based hypofractionated radiotherapy, such as in the PACE B protocol. Participate in and await trial data from other hypofractionation trials. Read and/or implement guidelines.”

Dr. Hunt urged the rest of the audience to make every treatment count. “I hope you’ll take something away from today’s Plenary Session. May it inspire you to think about what you can do not just for the workplace. No one’s going to make healthcare sustainable for us. It has to come from within.”

On surgery

“25% of hospital waste comes from the OR,” stated Dr. Benjamin Pradère (FR), who shared the “climate-smart actions”: sustainability, reduce waste, recycle, reuse, and reduce energy consumption in his presentation “Sustainable treatments: Surgery”.

According to Dr. Pradère, education for segregation is key. Most of the waste can be considered as regular/uncontaminated waste. He underscored the importance of proposing dedicated recycling facilities for segregation. He added that preoperative waste comes from the devices used, and that there is an urgent need for recycling programmes and other manufacturing/packaging modifications.

Dr. Pradère provided examples of more sustainable practices in surgical care. He noted that spinal anaesthesia produces 67 times less greenhouse gas (GHG) emissions compared to general anaesthesia. He discussed the advantages and disadvantages of reusable products (i.e., regarding endoscopic instruments). He encouraged combating planned obsolescence by powering down consoles and streamlining data management. Separating waste generated before the operating room from intraoperative waste was associated with a 50% reduction in annual waste output. He also promoted performing TURBT procedures in ambulatory settings. He added to favour oral postoperative treatments.

According to Dr. Pradère, energy consumption is the largest source of GHG emissions in the surgical environment; thus, reducing the use of heating, ventilation, and air-conditioning systems and powering operating rooms with clean energy were recommended strategies.

On medical oncology

Some of what medical oncologist Prof. Yüksel Ürün (TR) discussed in his presentation “Sustainable Treatments: Medical oncology” were the exploration of the clinical, economic, environmental, and social dimensions of sustainable genitourinary (GU) cancer care. Clinically, he emphasised the importance of smarter trials, leveraging real-world data, treatment de-escalation, and shorter therapy durations. From an economic perspective, he highlighted value-based care and outcome-linked pricing. On the environmental front, he discussed initiatives such as green hospitals, renewable energy, reducing drug waste, and sustainable supply chains. Socially, he underscored the need for diversity in clinical trials and empowering patients as co-creators in their care.

Medical oncologist Dr. Elena Castro (ES), nuclear medicine physician Prof. Dr. Karolien Goffin (BE), urologist Dr. Laurence Klotz (CA), and radiation oncologist Prof. Thomas Zilli (CH) spearheaded the Plenary Session.

(Re)view all their presentations via the EMUC25 Resource Centre.

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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.

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ZIRCON
During his presentation, “ZIRCON – Girentuximab-PET/CT in RCC phase III trial”, Prof. Peter Mulders (NL) stated that the ZIRCON (Zirconium in Renal Cancer Oncology, NCT03849118) Phase III pivotal study with 89Zr-DFO-girentuximab has met its primary endpoint. The study exceeded sensitivity and specificity targets, and met its key secondary endpoint of sensitivity and specificity in small masses (cT1a ≤4cm).

Furthermore, the study corroborated a favourable safety and tolerability profile of 89Zr-DFO-girentuximab. Results suggested that 89Zr-DFO-girentuximab improves the identification of primary clear cell renal cell carcinoma (ccRCC) compared to cross-sectional imaging.

Prof. Mulders underscored that 89Zr-DFO-girentuximab has the potential to improve management by aiding risk stratification, selecting appropriate patients for treatment, or suggesting where further imaging/biopsy could be indicated. In addition, 89Zr-DFO-girentuximab exhibits potential such as in the improvement of staging in ccRCC, and more.

PRIME
In his presentation, “Comparison of biparametric and multiparametric magnetic resonance imaging for prostate cancer detection: An update on the PRIME Study (NCT04571840)”, Prof. Kasivisvanathan stated that previous studies comparing biparametric (bpMRI) and multiparametric MRI (mpMRI) had limitations. These were the inclusion of small, single-centre, or retrospective studies; lack of strict blinding of radiologists when reporting both bpMRI and mpMRI; and no MRI quality control, to name a few. Hence, the inception of the PRIME study.

With broad participation across five continents, the PRIME study is a 500-patient prospective, within-patient, multicentre, level 1-evidence study. It investigates whether bpMRI is non-inferior to mpMRI in the detection of clinically significant prostate cancer (csPCa).

Since MRI quality control was central to designing PRIME, the aim was to evaluate the quality of all MRI scanners taking part in PRIME using the PI-QUAL score, and to make suggestions on how to improve MR protocols to ensure all scanners taking part were of optimal diagnostic quality, PI-QUAL 5.

Prof. Kasivisvanathan stated that the study aims to provide high-quality evidence on whether bpMRI can become the new standard of care for PCa diagnosis. The core objective is to streamline the PCa diagnosis pathway for men to be able to access MRI when needed.

The results of the PRIME study will be published in six months.

PRECISE

The key takeaways of the presentation “PRECISE trial: MRI features predicting active surveillance failure” by Dr. Armando Stabile (IT) were that the PRECISE score alone is not enough to decide on whether to perform a follow-up biopsy under active surveillance. He added, “For patients with excellent characteristics at the baseline with a serial MRI that is reassuring, this subset of patients need not be considered for a follow-up biopsy because they have a very low risk of long-term reclassification.”

In addition, the PRECISE score should be used in combination with biomarkers (e.g. PSAD [prostate specific antigen density], etc.) to decrease the proportion of useless biopsies.

According to Dr. Stabile, the baseline PI-RADS score is one of the strongest predictors. As an example, he advised that if a patient has a PIRADS 4-5 score that improves over time to still monitor that patient as there is still a small risk for him to progress to the mid-term [classification].”

Dr. Stabile emphasised that the PRECISE score holds its predictive value over time.

Review the take-home messages of the session and watch the complete presentations via the EMUC23 Resource Centre.

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