SPARC the conversation

In “SPARC initiative: The final consensus”, Dr. Jochen Walz (FR) emphasised, “PSMA theranostics in PCa is here to stay. Several publications have shown the benefits of using PSMA technology to improve the management of our patients. What we lack is a common language.” According to Dr. Walz, there is an absence of standardised and accepted reporting of PSMA-PET. Clear and standardised communication between nuclear medicine physicians and clinicians (e.g., urologists, medical oncologists, radiotherapists, etc.) is essential

“The summary of the consensus we generated and the reporting standards established concerning detection (i.e., looking for PCa in a patient that was not yet diagnosed with PCa similar to what mpMRI is doing nowadays) is that MRI is not first-line for detection. There might be cases of inconclusive MRI, the same with biopsy findings. Added information might be of value,” said Dr. Walz. He underscored that a biopsy is still necessary, “even if it is PI-RADS 5, SUV > 12; even if MRI and PSMA-PET results are negative, but there is a strong suspicion that the patient has PCa.”

Dr. Walz also provided the consensus on the standards of PSMA-PET reporting on primary staging, biochemical recurrence, and treatment response.

APCCC diagnostics disparities
In the first part of the presentation, “APCCC diagnostics: Agreements and disagreements”, medical oncologist Dr. Fabio Turco (CH) provided the aims of the APCCC, such as:

1. Gather recommendations on managing advanced PCa, especially in areas where evidence is scarce or conflicting, or if there is a different interpretation of evidence
2. Knowledge translation
3. Identify knowledge gaps

Prof. Goffin then discussed the APCCC Diagnostics 2025, which comprised 88 questions divided into six categories: how to diagnose PCa; how to stage PCa; biochemical recurrence; metastatic disease: What to do; monitoring metastatic PCa; and radioligand therapy and imaging. Prof. Goffin also shared some of the questions which resulted in disparities among recommendations. The APCCC Diagnostics 2025 paper is ongoing. The call for abstracts deadline is 23 November 2025.

Renewed interest in tracers

In his presentation “Advances in molecular imaging in renal cancer”, nuclear medicine physician Dr. Clément Bailly (FR) stated that there is limited performance of tracers in nuclear medicine for the diagnosis of kidney cancer, but there is renewed interest tracers, particularly in theranostics. He focused on Carbonic Anhydrase IX (CA IX), which is a cell-surface glycoprotein that contributes to pH regulation. He stated that CA IX expression in non-cancerous tissues is rare and generally confined to the epithelia of the stomach, gallbladder, pancreas, and intestine. The expression is notably induced by hypoxia, and is notably induced as a consequence of the inactivating mutation of the pHVL tumour suppressor protein.

(Re)watch the full presentations via the EMUC25 Resource Centre.

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During “Treatment response criteria in mHSPC”, Dr. Wolfgang Fendler (DE), concluded that “Radiographic outcomes are number one for clinical trials on metastatic hormone-sensitive prostate cancer (mHSPC). Most of the radiographic response is often in line with or similar to the Prostate Cancer Working Group 3 (PCWG3) criteria.” He added that standardised reporting – prostate cancer molecular imaging standardised evaluation (PROMISE) – and PSMA-PET response criteria such as PSMA PET progression (PPP) and Response Evaluation Criteria in PSMA-imaging (RECIP) have been defined and are currently reviewed and renewed by the PCWG4.

Novel biomarkers

According to medical oncologist Dr. Gerhardt Attard (GB), the combination of androgen deprivation therapy (ADT), androgen receptor pathway inhibitor (ARPI) , and ARPI + radiotherapy (RT) (for low volume) should be the treatment backbone for mHSPC. “We want to intensify further treatments to that backbone. Molecular transcriptome expression-based tests could play a role in patient management but more data sets are required for practice change.”

In his presentation “Implementation of novel biomarkers for metastatic prostate cancer starting androgen deprivation therapy”, he also stated that clinical implications of some biological processes appear to differ by the metastatic state in terms of tumour load at presentation, underlying biology, and various treatment paradigms.

SBRT matters

In “Stereotactic body radiation therapy for oligoprogression in prostate cancer”, Dr. Tree stated that there is good evidence that RT for oligoprogressive prostate cancer improves PSA control. As seen in the ARTO trial, RT delays the time until the next treatment. More work is needed to determine if RT improves overall survival. She added that the optimal time to consolidate with RT is unknown or if it should be performed at different hormone-sensitive settings in the metastatic arena.

View the presentations in detail in the EMUC24 Resource Centre.

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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.

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