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.

Swedish OPT
Dr. Rebecka Arnsrud Godtman (SE) presented “The Swedish experience – 4 years of OPT” which focused on the population-based, screening-like programme with a pre-defined algorithm.

Dr. Godtman provided the results of the OPT from 2020 to 2023 which involved men aged 50 to 55. Out of almost 140,000 invitations sent, participation was at 34%. Compliance of participants involving MRI and biopsy was high. Results of the 1,373 MRIs showed PI-RADS 1 to 2 was at 68%, PI-RADS 3 at 19%, and PI-RADS 4 to 5 at 12%. Of the 440 biopsies performed, 42% were benign, 19% had Gleason score 6, 32% had Gleason score 7, 5% had Gleason score 8 to 10, and 2% had no Gleason score.

Dr. Godtman also shared five key learning experiences:

1. Planning is essential. To estimate flows and necessary resources, simulation models should be developed. Before starting, the necessary resources for all diagnostic steps and treatment should be secured. To test infrastructure and identify pitfalls​, carry out a pilot project (not too small) or start stepwise.
2.  A change of perspective – the OPT philosophy. An algorithm that minimises individualisation that reaches dichotomous algorithm outcomes must be established.
3. Communication is key. Constant contact with all stakeholders is crucial. Involve professional communicators and the target population. Persuading people to comprehend and comply is a complex task.
4. Building the first round of the algorithm is easy but the subsequent ones are increasingly difficult.
5. Register, analyse, and provide feedback on all outcomes.

PROBASE
In “The German experience: PROBASE trial”, presenter Prof. Peter Albers (DE) concluded that risk-adapted organised screening such as in PROBASE is a valid strategy because baseline prostate-specific antigen (PSA) in young men (aged 45 to 50) works and is recognised. Furthermore, he stated, “Baseline PSA is important and it is currently the best way to prevent prostate cancer mortality. However, you have to stay away from further investigations if you have low PSA.”

Prof. Albers added that baseline PSA reduces harm for men who are not at risk or low risk. It prevents opportunistic screening with reduced screening intervals (every 5 years). He added that if started early (45 to 50 years of age), it is probable that all relevant cancers will be detected, and with personalised treatment such as active surveillance, harm will further diminish. However, challenges remain such as the beginning and end of screening, as well as the quality of MRIs.

In the next few years, PROBASE aims to determine if AI will improve MRI reading; whether serum/urine biomarkers can be used before MRI; how to increase the acceptance of screening; and if there are sociodemographic differences.

TRANSFORM
The TRANSFORM trial is anticipated to be the biggest trial in prostate cancer (PCa) screening aimed to determine the best way to screen in a 20-year timeframe. The trial has been developed in consultation and support of the National Health Service (NHS), the National Institute for Health and Care Research (NIHR) and the UK Government.

In his presentation, “The British programme: TRANSFORM trial”, Prof. Mark Emberton (GB) discussed the three stages of the trial:

• Stage 1 will pilot new screening interventions and evaluate how to deliver a pivotal trial by accessing key trial processes and assumptions.

• Stage 2 will conduct the pivotal clinical trial and create a biobank with clinical and imaging data alongside a fluidic, histological and tissue archive.

• Stage 3 will evaluate long-term primary outcomes from the trial through linkage to national databases.

Prof. Emberton stated, “We have agreed on the design of a new prostate cancer screening study. It’s a fantastic achievement. The funding for Phase 1 is in place. The trial has support from the NIHR and the UK government, this may encourage other international groups to adopt complementary designs.”

PRAISE-U
A project aimed at reducing morbidity and mortality caused by PCa in the EU, PRAISE-U focuses on early detection, protocol alignment, data collection, risk-based approach, and knowledge sharing. The initiative is a consortium of 25 institutions from 12 member states.

“PRAISE-U: Updates from the pilot studies (Work Package 2)” by Dr. Katharina Beyer (NL) showed that the screening strategy in the pilots currently involves countries Lithuania, Spain (Galicia and Manresa), Poland, and Ireland. Since the initiative has only been in place for a few months, more information is to be expected. Invitations have been sent to potential participants in Galicia, Manresa and Poland.

Dr. Beyer stated that PRAISE-U is “building current knowledge on a long road of screening history in PCa, and important insights are being acquired and action will be taken (i.e., risk-based screening). PRAISE-U offers a new opportunity to apply fresh learnings and aims for more understanding outside the trial setting.”

Prof. Albers and Chair of the EAU Section on Urological Imaging Prof. Francesco Sanguedolce (ES) spearheaded the Plenary Session.

To watch the full presentations, please visit the EMUC24 Resource Centre.

The post Current evidence in PCa screening appeared first on EMUC25.

Grounds for RCC screening

“RCC screening is a topic of great interest to patients, clinicians, and policymakers. Fascinating data will come from the Yorkshire Kidney Screening Trial (YKST),” stated urologist Prof. Grant Stewart (GB) during his presentation “Rationale for renal cell carcinoma screening”.

A sub-study of the Yorkshire Lung Screening Trial, the YKST is a targeted screening of high-risk individuals already attending for another screen test. The recruitment of 4,000 participants was completed in October 2022 and the six-month outcome review came out in May 2023. In January 2024, the report will be published.

Prof. Stewart referred to the Wilson and Jungner/WHO screening criteria, which often represent the de facto starting point for screening decisions today. The criteria comprised 10 principles and Prof. Stewart correlated each principle with the current data available for kidney cancer:

1. The condition sought should be an important health problem
   “In the UK, kidney cancer is the 7th most common cancer wherein 50% of patients die. An increase in the disease’s incidence in the next 10 years is predicted.”
2. Facilities for diagnosis and treatment should be available.
   “There are well-established diagnostic and treatment pathways.”
3. There should be an accepted treatment for patients with recognised disease.
   “The range of options for patients include surgery, ablation, and active surveillance.”
4. There should be a latent or early symptomatic stage.
   “Yes, there is when it comes to small renal cancer but the vast majority is asymptomatic. This is why we need a way of identification.”
5. The natural history of the condition, including the development from latent to declared disease, should be adequately understood.
   “Yes, it is partially as all lethal RCCs start as small cancers. However, currently, it cannot be predicted which small renal cancers will progress.”
6. There should be a suitable test or examination.
   “Yes, ultrasound or LDCT (low-dose nonenhanced computed tomography) is used.”
7. The test should be acceptable to the population.
   “There is apparent patient accessibility.” Prof. Stewart presented the findings of an online survey concerning public attitudes toward screening for kidney cancer regarding the five screening modalities: urine, blood, ultrasound, kidney computed tomography (CT), combined kidney and lung CT. The majority have opted for the combined kidney and lung CT.
8. There should be an agreed policy on whom to treat patients.
   “Yes, there is with all renal mass patients but not necessarily with Sx/TA.”
9. The cost of case-finding (including diagnosis and treatment of patients diagnosed) should be economically balanced in relation to possible expenditure on medical care as a whole.
   “It is theoretically proven for surgery to be more economical when compared to drugs.”
10. Case-finding should be a continuing process and not a “once and for all” project.
    “This is still unknown. Is repeated screening economically viable?”

Interception to prevent urothelial cancer

During the presentation “Large-scale interception using personalised prevention algorithms – an opportunity for urothelial cancer screening”, medical oncologist, Asst. Prof. Ronan Flippot (FR), stated that urothelial cancer is the 6th most common cancer type wherein 25% to 30% is muscle-invasive presentation, and a five-year survival rate (i.e. 70% localised, 40% regional and <10% distant). The disease affects the ageing population (the median age of onset is 75 years) and frail comorbid patients.

According to Prof. Flippot, a large-scale interception programme has the potential to improve bladder cancer screening. Adherence of patients and ambulatory care professionals, and funding are paramount. He underscored that an interception programme can be significant for prospective screening trials and interventional strategies evaluation in multiple-risk settings. Furthermore, the constitution of biobanks will bring value to molecular detection programmes.

To learn more, access the full presentations of Plenary Session 1 through the EMUC23 Resource Centre.

The post EMUC23: What’s new in GU screening? appeared first on EMUC25.

The experts gave their view on the continued use of PSA as a screening tool and the current state (and future potential) of imaging or biomarker-based alternatives.

The 11th edition of the European Multidisciplinary Meeting on Urological Cancers is taking place in Vienna on 15-17 November. It was preceded by the 8th Meeting of the EAU Section of Urological Imaging and other supplementary meetings on the 14th. EMUC19 is a collaboration of the European Society for Medical Oncology (ESMO), the European Society for Radiotherapy & Oncology (ESTRO) and the European Association of Urology (EAU).

A case for timely detection

Prof. Chris Bangma (Rotterdam, NL), urologist, co-chaired the session on early detection and the 40 years of PSA. He suggested that the audience use the coffee break after the session to celebrate the milestone. Its discovery in 1979 had a huge impact on the medical profession, patients and governments alike.

As an illustration of how far we’ve come (and perhaps as a warning if PSA testing is recklessly abandoned) Prof. Roobol (Rotterdam, NL) painted a picture of prostate cancer diagnosis and treatment in the 1970s and 80s. Patients were diagnosed at a point where the cancer had spread to bones and only one in 2-3 patients survived. Following a huge rise in PSA testing in the early 2000s, there followed a reflective period and fear of overdiagnosis. “But stopping PSA testing is not the way to go,” warned Roobol, fearing a return to mortality levels of the 1980s.

“We have to preserve the achievements of recent decades and work on preventing the excesses. In two words: Risk Assessment.” Roobol proposed an approach for 2019 and beyond that started with baseline PSA, then risk stratification, imaging, further risk stratification, biopsy, and then treatment  (including active surveillance) if required.

Earlier in the session, Prof. Hein Van Poppel lamented the recent decline in PSA screening and the associated increase in mortality in several Western European countries. “This could be prevented with early detection and appropriate treatment.” Van Poppel warned the audience for what he termed “anti-PSA propaganda” and the discouragement of PSA use. He concluded that effective use of supplementary tools and technologies like new biomarkers and MRI can avoid overdiagnosis and overtreatment.

Crucially, Van Poppel argued that Europe’s adult male population “needs to be informed” directly, thereby increasing awareness of PSA testing and the importance of early detection. The EAU is also working in a wider coalition of experts and patient organisations to lobby the European Commission to recommend population-based screening and hopefully change national guidelines. This is part of a longer strategy that was outlined at the EAU’s National Societies Meeting earlier this year and further detailed in an opinion piece on behalf of the EAU.

Van Poppel also hailed EMUC as a major achievement, a real multidisciplinary meeting that reflected the reality that urinary cancers no longer belong to a single specialty.

A voice to be heard

The morning’s session progressed to include the current state and (near-)future potential of various early detection options including MRI (specifically PI-RADS), the grading system used by pathologists, and biomarkers and genomics. A lot of discussions took place in between the talks, covering topics like certification for hypothetical prostate imaging centres, and the role of artificial intelligence in risk stratification.

One discussion focused on the needs of patients and their experiences with their GPs: Dr. Erik Briers (Hasselt, BE) who was in the audience and identified himself as a prostate cancer patient mentioned the “own way of thinking” that general practitioners had when it came to their patients and prostate cancer.

“They feel that they have to protect men from overdiagnosis and overtreatment. But actually, men want to know about their prostate cancer when it is still curable. It might help to adjust the training of GPs, they have to learn that urologists and other disciplines are not out to take our prostates. They want to help us in the best possible way, and our doctors should not be afraid to refer us to a specialist.”

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