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.

The post ESUI meeting examines novel imaging trials appeared first on EMUC25.

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).

The post ESUI: Getting ready for the new EU approach to PCa screening 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.

The post New developments in imaging have great potential to change treatment in the coming years appeared first on EMUC25.

The ESU/ESUI Hands-on Training Course in Prostate MRI reading for urologists was designed to help urologists understand the role of magnetic resonance imaging (MRI) in the management of patients with prostate cancer (PCa) and how they can use the procured information.

The faculty members of the HoT course were comprised of internationally-known experts such as Course Chair Dr. Jochen Walz (FR), Prof. Dr. Jurgen Futterer (NL), Dr. Gianluca Giannarini (IT), Prof. Valeria Panebianco (IT) and Dr. Francesco Sanguedolce (ES).

“Why is MRI important to the urologist? For the same reason as computerized tomography (CT) scan has become fundamental in our practice,” said Dr. Sanguedolce. 

Delegates were familiarised with the imaging workstation; the basic concepts/principles behind different MRI sequences such as T2-weighted imaging, Diffusion Weighted Imaging (DWI) and Dynamic Contrast Enhanced (DCE) imaging; and the viewing order of sequences when interpreting prostate MRI.

The delegates also learned how to use the PI-RADS and Likert scoring system to score MRIs, know more about the standards for a prostate MRI and the quality criteria to meet. Prof. Futterer gave an overview of the minimum requirements to achieve quality MRI images. Prof. Panebianco discussed assessment categories of PI-RADSv2 and the roles of different scores.

Each delegate was provided with a laptop to work with to follow the lectures and partake in exercises. 

MRI Fusion biopsy

Through the guidance of Course Chair Dr. Lars Budäus (DE) with mentors Asst. Prof. Jan Philipp Radtke (DE), Dr. Karsten Gunzel (DE), Dr. Silvan Boxler (CH), Dr. Angelika Borkowetz (DE) and Dr. Andreas Maxeiner (DE), delegates learned about the advantages, handling and limitations of MRI Ultrasound fusion biopsies during the HOT course the ESU/ESUI Hands-on Training Course in MRI Fusion biopsy.

The course delivered an overview on MRI reading, technical basics, and different prostate biopsy approaches. Technical considerations, the transrectal or transperineal approach were reviewed and discussed. 

The delegates were divided into small groups to gain familiarity with the 5 different Fusion biopsy machines provided during the HOT course. The groups on each machine rotated every 10 minutes.

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