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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Prof. Georg Salomon (DE) and Dr. Jochen Walz (FR) chaired the session, which also covered topics on the enhancement of access to radiotheranostics for cancer care through the Oncidium initiative, as well as the different tracers for various indications in every cancer type.

In her presentation, “Current challenges of PSMA PET/CT in prostate cancer”, Assoc. Prof. Daniela Oprea-Lager (NL) cited the EAU Guidelines on Prostate Cancer, which stated PSMA PET/CT is more accurate for staging than CT and bone scan for high-risk disease but to date, no outcome data exists to inform subsequent management.

One of the recommendations of the EAU Guidelines with a “Strong” strength rating was when using PSMA PET or whole-body MRI to increase sensitivity, be aware of the lack of outcome data of subsequent treatment changes.

Assoc. Prof. Oprea-Lager concluded, “We cannot ignore modern imaging techniques and continue re(staging) and treating disease as we did in the era of conventional imaging.” She added that clinical outcomes such as overall survival, disease recurrence, and quality of life should be proven first. Learning how to interpret modern imaging properly and how to treat patients is imperative.

View the session recap and watch the full presentations on the EMUC23 Resource Centre.

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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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