Session report: The future of finding cancer

“Without the right clinical question, even the best technology is useless,” said Prof. Konrad Stock (DE), opening a discussion on whole-body MRI (WB-MRI) as a screening tool in healthy individuals. Read this report featuring lectures by Profs. Grant Stewart (GB), Laurence Klotz (CA), and Giuseppe Petralia (IT) on the future directions in early cancer detection.

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Webcasts of the day

Watch the introduction of the patient case here by A. Van Der Heijden, Nijmegen (NL).

Imaging Plenary Session 3
Rapid case debate: Cystectomy without TURBT
Yes, we can
J. D. Kelly (GB)

Imaging Plenary Session 3
Rapid case debate: Cystectomy without TURBT
No, it’s madness
M. Rouprêt, Paris (FR)

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Session report: SPARC, APCCC, and a new RCC tracer

What are the conclusions of the Standardised PSMA PET Reporting Concensus (SPARC)? Are there disparities in the Advanced Prostate Cancer Consensus Conference (APCCC) diagnostics? What is the latest tracer in the diagnosis of kidney cancer? Led by the Chair of the EAU Section of Urological Imaging, Prof. Francesco Sanguedolce (ES), together with nuclear medicine physician, Prof. Karolien Goffin (BE), the “Joint Session of the EAU Section of Urological Imaging and European Association of Nuclear Medicine” provided insights into these questions.

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Photos and Imaging Abstract Award Winners

Check out our photo albums of Day 1 of EMUC25 and Abstract Award winners on Facebook. Share your photos and stories on Instagram, LinkedIn, and X as well.

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Best imaging abstracts

LBO01: Impact of Initial PSMA-PET/CT Staging and PSMA-Targeted Biopsies on Treatment Decisions in Prostate Cancer: Results from the Phase II DEPROMP Trial
P. Krausewitz, Bonn (DE)

O08: The RING study: A European registry of next-generation imaging in advanced prostate cancer – protocol and preliminary findings
D. Chernysheva, Tashkent (UZ)

O12: A retrospective study of the diagnostic performance of CT urography vs. ureterorenoscopy in the follow-up setting of kidney-sparing surgery for upper tract urothelial carcinoma
O. Figaroa, Amsterdam (NL)

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EMUC25 Resource Centre

Missed a session? All webcasts, videos, posters and full-text abstracts EMUC25 are available via the Resource Centre.

For participants, viewing EMUC25 webcasts will also earn you CME accreditation. Webcasts are accredited up until Monday, 17 November 2025 (13:00 CET).

The post Highlights from Day 1 at EMUC25 appeared first on EMUC25.

AI: New horizons in urological practice

In his presentation “AI for pathology reporting”, Prof. Geert Litjens (NL) reviewed diagnostic, prognostic and predictive applications of AI in urological cancers, highlighting that AI can support cancer detection and Gleason grading at expert level.  However, he stresses the continued need for more transparent systems, as seen in the work by Sun et al. in Medical image computing and computer assisted interventions (2025).

Prof. Litjens also emphasised the need for better multimodal integration in AI. “The current AI models lack multimodal integration for accurate biochemical prediction occurrence (BCR)”. He highlights the recent CHIMERA (Combining Histology, medical (radiology) and molecular data for medical pRognosis and diagnosis) Challenge, which aims to advance precision medicine through its uniquely composed multimodal dataset. CHIMERA is a multimodal AI model combining transcriptomics, histopathology and radiology. Tasks include pairing MRI plus pathology of the prostate to predict biochemical recurrence (BCR), and pairing H & E (haematoxylin and eosin staining) plus RNA (ribonucleic acid) data of bladder cancer to predict overall survival. He expects this to have a big impact on AI-driven PCa research.

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“The future is not man versus machine but man with machine”, stated Ass. Prof. Giuseppe Fanelli (IT) in his presentation on ‘prostate cancer pathology in the AI era: Impact and horizons’, where he highlighted that AI tools are powerful assistants, but accountability remains with the pathologists. “Vendors and institutions share responsibility through proper validation, monitoring, and compliance with regulatory frameworks.”

He illustrates how AI is being used for computational pathology with its ability to extract clinically actionable knowledge using computational methods from complex, high-dimensional laboratory and clinical data, thereby yielding more precise diagnosis, disease stratification, and selection of patient-specific treatments.

Ass. Prof. Fanelli stresses that data alone is not enough, analysis tools are required. “There are many vendor solutions and general-purpose machine learning tools, but none satisfied all our requirements, so we built our own.” He shares details of the PathML, which is a fully open-source research toolkit able to support the entire digital pathology research workflow.

The next step to advancing pathology digitalisation according to Ass. Prof. Fanelli is the integration of digital slides data with clinical, radiological and genomic information.

You can watch the full presentations via webcast recordings at the EMUC25 Resource Centre.

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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.

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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With five ESUI plenary sessions on the agenda, the meeting began with the ‘The future of prostate cancer screening programme in EU: Evidence, technologies and strategies’, led by Prof. Lars Budäus (DE) and ESUI Chair Prof. Francesco Sanguedolce (ES).

Customised and risk-based screening

EAU Policy Office Chair Prof. Hein Van Poppel (BE) presented the opening lecture, ‘EU recommendations on PCa screening programme: What we expect in the next 5 years’. He stated that 417,000 men in Europe are diagnosed with prostate cancer (PCa) every year, more than two million European men are living with prostate cancer, and 92,200 European men die of PCa each year.

Prof. Van Poppel: “We convinced policymakers of the problem and the need to decrease PCa deaths.  Stop the increasing rate of too-late diagnosis, stop the costly and inappropriate/inefficient opportunistic testing, and improve the quality of life (QoL) of PCa patients”. He stated that the solution is organised screening throughout Europe, and emphasised the importance of early detection in well-informed men.

The EU4Health called for proposals for innovative approaches to PCa screening, and in partnership with a network of consortium members, PRAISE-U (Prostate cancer Awareness and Initiative for Screening European Union) was set up to encourage early detection and diagnosis of PCa through customised and risk-based screening programmes. According to Prof. Van Poppel there will be five pilot studies in the EU in 2024, and a report submitted to the European Commission in 2026.

MRI challenges

Looking into the complexities of screening populations, radiologist Dr. Ivo Schoots (NL) delivered a lecture on ‘Challenges of MRI in (any) screening programmes’.

Dr. Schoots: “For prostate MRI, population PCa screening is now a new indication, however, PCa screening with MRI needs to be clearly understood by radiological and urological services, and MRI needs to be optimised before implementation into the screening pathway”.

“I want to stress that PCa screening is only acceptable if it is programmatic, and we can reduce harm (while maintaining and improving detection rates), such as using MRI to avoid biopsies, stop doing systemic (blind) biopsies, perform safer and more accurate MRI-directed biopsy, and increase uptake of active surveillance.”

According to Dr. Schoots, MRI-pathway limitations in secondary care will also be translated into primary screening. He discusses the harm of false positives, limited availability of high-quality MRI’s, requirements of specialised equipment, and training.

An update on lung cancer screening model

Continuing on the topic of screening models, Prof. Torsten Gerriet Blum (DE) presented a lecture on ‘The lung cancer screening model’. He stated that low-dose CT lung cancer screening is very promising but it does need time, joint actions and resilience to successfully implement.

Prof. Blum: “When reviewing low-dose CT lung cancer screening, there is RCT-based evidence demonstrating efficacy and cost-effectiveness in risk populations. Overdiagnosis and over therapy is probably the most relevant problem. There are implementation studies (Croatian national programme) demonstrating efficacy and safety.”

He also pointed out the essential need for a structured programme with robust algorithms for LDCT (low-dose computed tomography) reading and nodule management, as well as quality assurance.

This Plenary Session also included a session on “Prostate cancer screening: The PSA/biomarker implemented pathway”, with presentations on the GOTEBORG-2 trial, and ProSa trial. The Prostagram Trial and Re-Imagine trial were presented in the “PCa screening – The MRI only pathway”.

Watch the full presentations from ESUI Plenary Session 1 via the Resource Centre – EMUC23 (uroweb.org).

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ESUI22 is being held in conjunction with EMUC22, the 14^th European Multidisciplinary Congress on Urological Cancers, and a variety of satellite meetings. Together, this four-day event gives an extensive update on urological cancers in a multidisciplinary perspective, featuring speakers representing ESMO, ESTRO and the EAU.

Potential of AI

In the first plenary session “Standard today, but what about tomorrow?” radiologist Prof. Jelle Barentsz (Nijmegen, NL) presented the need for new protocols of quality control in imaging, and re-assessed the role of artificial intelligence (AI) now that its use has widened.

AI had made improvements, even in the past two years, but it still cannot compete with an expert gaze. It is however approaching the level of skill of a typical radiologist and this opens up new possibilities. According to Prof. Barentsz, AI is the radiologist’s friend and can help diagnosis in several ways. “Use of AI can shorten reporting time, and helps the radiologist with easy, more obvious cases. It can make the report and annotate the region, speeding up evaluation time. It also improves detection by offering a ‘double read’: an extra check by a computer that’s never tired.”

Importantly, the radiologist “remains in control” but AI can ease the workload, especially in the post-COVID period where medical experts are prone to burn-outs. The radiologist can focus on consulting, and has more time for creative thought. Interestingly, use of AI also allows integration with non-imaging tools and other “-omics”.

Prof. Barentsz went on to give a quick overview of his experiences with the Transurethral Ultrasound Ablation, or TULSA, procedure at the Busch Center (in Alpharetta GA, USA). Initial impressions left him “flabbergasted”, and he concluded that it will certainly play a role in the coming years as a viable treatment option.

Other developments on the horizon

During the same session, Dr. Vincenzo Scattoni (Milan, IT) offered a urologist’s perspective on the development of TRUS over the past few decades. Dr. Scattoni concluded: “TRUS’s utility in clinical practice has been continuously confirmed over the years, but unfortunately there are no current developments that have proven to significantly improve cancer detection. Based on well-designed controlled studies, the combination of targeted biopsy schemes and systematic biopsies provides the highest detection rate.”

Prof. Frederik Giesel (Dusseldorf, DE) had a pre-recorded presentation on the different tracers that were beginning to see use in PSMA PET-CT. A particular highlight was the emergence of PSMA-ligand therapy, currently in Phase II trials and carefully starting to be included in medical guidelines: “Exciting times are waiting for us in the future of PSMA,” said Prof. Giesel.

The post ESUI22: Examining the near future of imaging appeared first on EMUC25.

EMUC congresses are typically organised to coincide with the Annual Meeting of the EAU Section for Urological Imaging (ESUI), as well as other imaging-specific workshops and meetings. With the move to an online congress, the wide imaging scientific programme was streamlined somewhat and integrated into the EMUC20 Virtual Congress.

It was in the tenth plenary session, ‘Fragments of Imaging’ that most of the latest developments in oncological urology-related imaging were presented. The Saturday afternoon session was chaired by ESUI Chairman Prof. Salomon (Hamburg, DE) and Prof. Sanguedolce (Barcelona, ES) and at its peak attracted some 470 simultaneous viewers (or 630 unique viewers spread out over the entire session). Many questions for the speakers were submitted through the Q&A system, several of which were covered in the discussion following the presentations.

Ultrasound has scope for improvement
Mr. Christophe Mannaerts (Nijmegen, NL) presented the latest developments in ultrasound, specifically when compared to the mpMRI pathway. The latter poses some challenges, including “costs and accessibility, inter-reader reproducibility, inter-operator reproducibility with the necessity of cross-modality registration, and the variability in results from different centres of expertise,” said Dr. Mannaerts, citing several recent publications.

Possible benefits of the use of (improved) ultrasound in urology include reduced costs, better accessibility and easier lesion targeting. This makes ultrasound a field that is worth further developing and refining, according to Mr. Mannaerts. Improvements can be found in the use of micro-ultrasound, working at 29MHz instead of the more traditional 8-12MHz. Mannaerts: “The use of this increased frequency has led to 300% improved resolution, revealing microstructures and tissue patterns. The PRI-MUS protocol has been developed for this case.” Other potential developments include novel modalities in ultrasound, like contrast ultrasound dispersion imaging (CUDI).

Mr. Mannaerts concluded that ultrasound imaging for PCa detection and localisation is improving, and it can become a more accessible and viable modality for targeted biopsy is improvements are made in developing a standardised acquisition and reporting scheme, and high-quality benchmarking with the mpMRI pathway in the same patient group.

Other presenters in the busy session were Prof. Jurgen Futterer (Nijmegen, NL), Prof. Frederik Giesel (Heidelberg, DE), Prof. Jelle Barentsz (Nijmegen, NL), and Prof. Valeria Panebianco (Rome, IT).

New directions in imaging
Prof. Futterer summarised developments in imaging in the past thirty years, indicating that abbreviated (or “fast”) MRI prostate protocols might make for an appealing option, depending on indications, cost, experience, and the development of smart algorithms and AI. Prof. Giesel discussed the “rising star” of imaging, the new fibroblast activation protein inhibitors (FAPI-)PET/CT. Advantages compared to FDG include no need for diet or fasting for patients and quicker image acquisition after tracer application. “FAPI opens a new application for PSMA-negative PCa patients,” Prof. Giesel concluded.

Prof. Barentsz, introduced by the moderators as “the father of the PI-RADS” presented some first results on the use of nanoparticles, and the perspective of their use as a contrast agent. Nano-MRI guided RT shows “promising results” in detecting small positive lymph nodes that PLND and PSMA PET/CT have trouble finding. Prof. Barentsz expects approval for the agent, MR-Linac, in the next two years.

“Can VI-RADS avoid TUR-B prior to radical cystectomy?” asked Prof. Panebianco in the final talk of the session. “Yes we can,” she concluded. Her presentation on the Vesical Imaging-Reporting and Data System proposed an MRI pathway for bladder cancer patient stratification: NMIBC vs MIBC, and MIBC-T2 vs Locally Advanced BC -T3–T4, only then sampling TUR for confirmatory pathology in VI-RADS 5.

The session closed with an unfortunately brief panel discussion on delegate’s questions. Considering the enthusiasm for the session, and the hotly anticipated new imaging technologies on display, urological cancer specialists can expect big changes in their imaging options in the near future.

EMUC20 delegates can re-watch the entire session (and the rest of EMUC20) through the EMUC20 Resource Centre. Contents will be constantly updated over the coming days.

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The speakers gave several examples of mimicking of PCa or of bone metastasis, or the grey areas within a PI-RADS scoring. Their talks gave the assembled urologists and oncology specialists a good idea of the possible false positives that have to be ruled out before any conclusions can be drawn from imaging or pathology. Following the session, we spoke to Prof. Thoeny about the topic, particularly what specialists can and should do in the case of a false positive.

Always consider the complete picture

Prof. Thoeny recommends looking at the whole history. “When it comes to PCa, always look at the morphology. But also the available clinical data, like the PSA. If there is a discrepancy (for instance a low PSA but a lot of metastasis), if there is a minimal doubt, you have to perform a biopsy to prove your theory. Chemo and hormone therapy have a huge impact on the patient and should be avoided if possible.”

“It is very difficult to draw conclusions on metastasis based PSMA-PET. I know that there is a lot of enthusiasm for the technology and it is sometimes considered to be the holy grail, but it’s not.”

Is imaging only suitable in combination with other methods? “No, I think MRI of the prostate, this is the way to go,” said Thoeny. “Of course you need extra training but I agree…”

The PI-RADS scale of course also has scope for false positives. “The difficult ones are PI-RADS 3, because you’re not sure how to proceed. Taking the PSA density into account can help you rule out false positives. There are plenty of calculators online. There is a cut-off of 0.12ng/ml. If it’s higher than 0.12, then it’s more aggressive, and if it’s lower we do a follow-up.”

A friend of a friend

Prof. Thoeny related a recent case she was involved in around two years ago, a friend of a friend in his early 50s. “His Gleason score was determined to be 6-8 following a biopsy. He went to have a PSMA-PET done. I hadn’t heard from him in a while. He later told me that he was told that he had bone metastasis and lymph node metastasis. They had said ‘Surgery can’t help you. You will get hormonal and radiotherapy, and possibly chemo. You have another 3-4 years left to live.’ He was in an intense shock. He walked out of the clinic and thought to himself: ‘I hope I’ll have a car accident,’ he didn’t want to live anymore.”

“The specialists had looked at morphology, and it looked really suspicious on the images. This seemed odd to me, considering that he had a stable PSA for 5 years. I asked him to send me all the images of the previous years. I went back and looked at the old MRIs, and you could tell that the bone lesions were there already 5 years ago. I told him: undergo surgery, have a lymph node dissection done. They were all negative. He’s now happy and in good shape.”

“We have no idea what caused the false positive, it’s still a mystery. There’s a lesson for today’s audience: if the whole story doesn’t fit together, you should be more critical. In the case of PSMA-PET, you should have a biopsy for confirmation before undergoing the extremely impactful systematic treatments. In the case of a prostate MRI, if you take PSA density into account, follow-up should be enough.”

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The programme launched with Plenary Session 01 “Prostate cancer management: Implementation without good evidence?” which was chaired by Prof. J. Oldenburg (GB), Prof. Dr. Kerstin Junker (DE), Prof. James N’Dow (GB) and Dr. Bradley Pieters (NL).

In his lecture “Functional imaging for recurrent disease”,  Dr. Stefano Fanti (IT) emphasised the relevance of performing more randomised and multi-centre studies to produce and procure more quality and robust data.

As he showed the model of the levels of the evidence pyramid, he said “You don’t have to take into account only  expert opinion;  you have to go through systematic reviews, randomised control trials, multi-centre trials as these are absolutely fundamental.”

As an example, he stated that data from his team’s study “PET/CT with ¹¹C-choline for evaluation of prostate cancer patients with biochemical recurrence: meta-analysis and critical review of available data” was incorporated into the EAU Guidelines. “It’s not only the matter of the final diagnostic accuracy but the fact that study has robust, validated data and better than the competitors’,” said Dr. Fanti. “We provide good images, as well as, good evidence.”

Digital slides
“Information, diagnostic and therapeutic approaches resulting from Digital GU Pathology can be more accurate with less uncertainty when sources are evaluated separately and/or individually. It requires knowledge of previous studies that contributed to the current utilisation and role of virtual slides and quantitative tissue analysis. An ability to integrate data from diverse tests will be required,” stated Prof. Rodolfo Montironi (IT) in his lecture “Digital GU pathology”.

Digital Pathology, also known as whole slide imaging (WSI), refers to the high-resolution digitization and storage of entire glass slides as digital (virtual) slides. The advantages of using these include image sharing, interactive publication, quantitative image analysis, and information fusion.

Image sharing can be used for teaching, consultation, remote interpretation, and quality assurance. A digital pathology platform allows instant sharing of WSI in review cases, as multiple pathologists can review the same case in parallel.

With regard to interactive publication, Prof. Montironi said “When we submit data to a journal, we like to include the images of the histology. So we upload the virtual slides. This means that the readers that can see the slide and all the details.”

Quantitative image analysis (computational pathology) is used for prostate cancer detection and grading; location and identification of High-Grade Prostatic Intraepithelial Neoplasia (HGPIN); malignancy-associated changes; and biomarker expression in individual cells.

Information Fusion is direct integration with data derived, for instance, from surgery and other imaging techniques, such as mpMRI.

Prof. Montironi also stated that the performance of digital pathology is equivalent to glass slide microscopy [Snead, et al 2016].

Sequencing of novel therapies
In his lecture “Sequencing of novel therapies in urogenital malignancies”, Dr. Sergio Bracarda (GB) stated that at present, Abiraterone (ABI) or docetaxel (DCT) plus androgen deprivation therapy (ADT) are the new standards of care for cases presenting with high-risk metastatic castration-sensitive prostate cancer (HR-mCSPC), but which is better is not yet known. He added that radiotherapy may be evaluated in cases presenting with LV (oligometastatic?) disease.

Dr. Bracarda said that immediate sequencing between ABI and Enzalutamide (ENZA) should be discouraged, while AR-V7 possibly remains only a prognostic tool; and asked about the relevance and role of Radium-223 (Ra-223).

He foresees that non-androgen receptor (AR) novel targeted therapies such as P13K/AKT or poly-ADP ribose polymerase (PARP) inhibitors, and other new agents, such as checkpoint inhibitors will enter the prescription (Rx) scenario. “These new agents, after being tested in biologically designed Phase III studies, will modify the actual clinical sequencing in a genome-based, step-by-step verified sequencing. The future is here!”

To know more, access the EMUC18 Resource Centre.

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