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 Laurence Klotz (CA), “The US and Canadian national guidelines are a mess”, both being inconsistent, as well as outdated, with conflicting interests between methodologists and clinicians.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

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After the unprecedented success of the last two annual meetings of the EAU Imaging Section within the EMUC scientific programme, expectations for this year’s meeting are very high. Efforts from the scientific committee have been made to build a comprehensive 2025 scientific programme, with artificial intelligence (AI) in onco-urology clinical practice as a key topic.

Artificial intelligence

Imaging is, in fact, the field where AI is most actively explored, and we will demonstrate how this technology can fundamentally support clinicians and surgeons in optimising the patient journey through cancer care. The meeting will open with a dedicated session on this topic, and delegates will also have the chance to learn more about useful AI applications throughout the rest of the scientific programme.

Screening and tissue sampling

Plenary 2 will feature a progress update of screening programmes across the main urological cancers, such as the Yorkshire screening trial for renal cancer using non-contrasted CT scan. A special “out-of-the box” lecture will share early experiences with whole-body MRI for general screening.

Imaging is advancing in such a way that tissue sampling is becoming less necessary for decision-making. A dynamic Plenary Session 3 will feature rapid fire debates based on clinical cases, questioning whether we can skip TURBT or biopsy before major interventions.

New recommendations on prostate biopsy have been released by the EAU Guidelines. However, clear standardisation of the procedural steps of a perilesional biopsy – and clarity on how prostate biopsy findings should guide localised treatment are still lacking. A consensus process has been initiated, and its main results will be shown during an exclusive review at the EMUC meeting.

Imaging abstract submissions

The 6 best abstracts on imaging in urological cancers will be awarded in the special session, so be sure to submit your imaging abstract before 1 August 2025 (23:59 CEST). The top 3 abstracts will win a prize.

Nuclear medicine and precision therapy

Nuclear medicine continues to evolve quickly in the field of imaging of urological cancers. A special joint session has been organised with the European Association of nuclear medicine and will highlight a summary from the recent APCCC diagnostic meeting, showcasing the most innovative tracers for the management of renal cancer.

Precision therapy in bladder cancer will be another hot topic, with exploration of how urologists can optimise their surgeries by selecting the right patients for an imaging-guided surgery or choosing the right targeted systemic treatment to the most suitable patient.

Game-changers

2025 to date has also seen a significant number of game-changing publications on imaging in urological cancers. In the final session of the meeting, delegates will have the unique opportunity to engage directly with the lead authors and ask questions about their findings and how to integrate these findings into everyday practice.

All of this is only possible thankfully to the world-class experts coming from all over the world and from different disciplines, who will fascinate the audience with their work and the dynamic interaction.

—-

See the imaging sessions, and the full EMUC25 scientific programme.

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Dr. Papanikolaou: “The main objectives of ProCancer-I is to deliver a PCa AI platform featuring a unique collection of PCa mpMRI images worldwide, in terms of data quantity, quality and diversity. This platform should produce novel AI clinical tools based on a three-stage ensemble modelling process for advancing characterisation of PCa lesions, assessment of the metastatic potential, and early detection of disease recurrence. Ultimately, the goal of this project is to contribute in the increase of the trust in PCa AI tools by introducing AI model interpretability functionality. We have been collecting data over 4 years, resulting in one of the biggest imaging databases for PCa with 12,816 patients and total images of 8,425,386, called ProstateNET.”

According to Dr. Papanikolaou, MRI issues include diagnostic delay, overdiagnosis, high interobserver variability (large differences between expert and non-expert radiologists), long exam times, and lack of predictivity. To address these issues, he outlines areas of the population screening pathway where AI could be a useful tool in the future. “The expectation of AI is for it to be more accurate (further increase in sensitivity and specificity), reduce reporting times and reduce unnecessary biopsies.”

Dr. Papanikolaou addressed several challenges with AI in the screening versus diagnosis set up, but also potential solutions. “A fundamental requirement in AI and machine learning is that someone should always use a model with data that are similar to the training dataset, which makes out-of-the-box use of diagnostic models to the general population not feasible. Not only are the imaging characteristics between the screening and the diagnostic scenario different, but most importantly, the prevalence of clinically significant disease is much lower in the screening population, as expected.”

“The simple way to solve this problem would be to collect data from the normal population and train new models from scratch, but given the very low prevalence of significant diseases, that would take a long time. A more sophisticated approach is transfer learning, where knowledge from one domain is adapted and transferred to another domain. Someone could consider the diagnostic models as the backbone of new screening models where, with fine-tuning, they can adapt to screening data. The latter scenario would need only a small portion of the entire dataset to be collected, which is more feasible than training from scratch.”

You can watch the full presentation at the EMUC24 Resource Centre.

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“The train has left the station”, stated Prof. Alberto Briganti (IT) when talking about conventional imaging in his presentation on the role of local treatment in M1a disease. “The panel of a Dutch multidisciplinary consensus meeting agreed that PSMA is the most appropriate standard imaging modality to identify de novo M1a (100%).”

According to Prof. Briganti, treatment of the primary tumour is invariably associated with better outcomes. In the EAU Guidelines, treatment of the primary is strongly recommended with radiation therapy (RT) and there is no strong comparative data with surgery. He stresses that there is a need to invest in future trials.

Systemic triplet

In his lecture, ‘Intensification of systemic treatment for men with de novo M1 disease’, Prof. Karim Fizazi (FR) shared a robust rationale for the use of systemic triplet therapy. “Both androgen receptor pathway inhibitors (ARPI) and taxanes are active after one fails. Poly-therapy is needed to target heterogeneity as some cells are resistant to androgen receptors (AR) targeting and some others are resistant to taxane. Until we have a biomarker to tease out AR/taxane sensitivity, a combination is required.”

Prof. Fizazi shared his six good reasons to use systemic triplet therapy in fit men with mCSPC: “It works! This is not a false positive and the control arm was just standard treatment. There is no available comparative data for triplet versus bi-hormonal therapy but the benefit is likely. The biological rationale is strong, and lastly, there is balance with efficacy and safety.”

According to Prof. Fizazi, the standard of care for 2023 for de novo high volume in fit men is ADT+docetaxel+abiraterone/pred or darolutamide (or enzalutamide). If men are unfit for docetaxel, then ADT+NHT is possible. In de novo low volume cases, he recommended it is possible to treat with ADT+NHT+RXT (PEACE-1 RT data), although this is more complex and the systemic triplet, it should be discussed on a one-by-one basis in terms of age, fitness, bone health, etc.

Looking to the future, Prof. Fizazi shared details on the next generation trials stratified on clinical/molecular biomarkers, such as the PEACE-6 programme, which has several ongoing and planned European trials in M1 CSPC.

De-escalating in HSPC? 

Prof. Bertrand Tombal (BE) presented a lecture on ‘De-escalating strategies in HSPC: who, when, how?’. He concluded that a significant proportion of patients achieve a profound PSA response (<0,2 ng.ml after treatment with ADT and an aRpl).

“Sub-analyses of the registration trials have consistently demonstrated that these patients have prolonged survival and, thus, prolonged exposure to treatment. There is an opportunity to revisit the concept of intermittent treatment as a strategy to reduce side effects, improve HR-QoL (health-related quality of life), and limit costs. This should be tested in clinical trials, properly assessing the risk and benefit of de-escalation.”

Prof. Tombol ended his presentation with some details of the new study ‘discrete choice experiment (DCE)’, designed in collaboration with EUROPA UOMO to understand patient’s assessment of the benefits and risks of intermittent versus continuous ADT (androgen deprivation therapy (ADT)). This study includes a qualitative phase with patient interviews and a discrete choice experiment survey for phase two.

You can watch a webcast recording of the full presentations on the EMUC23 Resource Centre.

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Urologist Ms. Maxine Tran (GB) delivered a presentation on ‘Nephron Sparing Treatment (NEST) for small renal masses’, a feasibility study of a cohort embedded randomised controlled trial comparing nephron sparing treatment for small renal masses.

Ms. Tran stated that feasibility of the trial was demonstrated, intervention was acceptable (85%), there were fewer complications, less reduction in renal function, reduced hospital stays, decrease in costs, and intervention showed equivalent cancer control.

In his presentation, ‘Update on PSMA targeting’, Dr. Andrea Farolfi (IT) shared results and comparisons of the PSMAfore (phase 3) and ENZA-p (phase 2) trials.

Dr. Farolfi: “PSMA-targeted radioligand therapy (RLT) is gaining momentum globally and there are new trials coming. Lutetium PSMA is quite active in this taxane-naïve metastatic castration-resistant prostate cancer (CRPC) space, and was extremely well tolerated. We have a new therapy that eventually, when regulators approve, will be available for patients in this space.”

“We do not need to sacrifice the quality of life (QoL) for oncological benefits. Enzalutamide combination and enzalutamide monotherapy do not negatively affect health-related quality of life (HRQoL),” stated Prof. Stephen Freedland (US) in his presentation on the EMBARK trial.

According to Prof. Freedland, in patients with high-risk biochemical recurrence (BCR) compared with leuprolide acetate, the enzalutamide combination demonstrated a statistically significant and clinically meaningful improvement in metastasis-free survival (MFS) (HR 0.42; 95% CI, 0.30-61; P<0.0001).

“Enzalutamide monotherapy also demonstrated statistically significant and clinically meaningful improvements in MFS (HR 0.63; 95%, CI 0.46-0.87; P=0.0049), time to PSA progression, and time to the first new antineoplastic therapy. No new safety signals observed to date with enzalutamide treatment”.

“Enzalutamide in combination with androgen deprivation therapy (ADT), if approved in this setting, has the potential to become a new standard of care for patients with high-risk BCR (biochemical recurrence).”

In her lecture, ‘Update on TALAPRO and PROpel’, medical oncologist Dr. Friederike Schlürmann (FR) shared a summary of game-changing improvements in overall survival (OS) over the years with the addition of PARPi to ADT+ARSI (androgen receptor signalling agent) in metastatic castration-resistant prostate cancer (mCRPC).

Dr. Schlürmann: “The TALAPRO and PROpel trials show clinical benefit beyond HRRm, and all trials support activity for PARPi + NHA in HRRm/BRCAm mCRPC. There must be caution with cross-trial comparison and differences in the study designs, populations and dosing schedules between trials may provide considerations for the differences seen between trials.”

On the topic of testing, Dr. Schlürmann stressed that somatic testing for BRCA1/2 has to become the standard of care in PCa.

Great news for BCa patients

Prof. Tom Powles (GB) was beamed in from America to deliver a presentation on the EVO-302/KEYNOTE-A39 trial. “This is the first time that platinum-based chemotherapy has been surpassed in OS in patients with previously untreated locally advanced/metastatic urothelial carcinoma (la/mUC). The overall results support enfortumab vedotin plus pembrolizumab (EV+P) as a potential new standard of care for 1L la/mUC.”

According to Prof. Powles, EV+P showed statistically significant and clinically meaningful improvement in efficacy over chemotherapy with a progression-free survival (PFS) of HR 0.45 and OS was 0.47%. Median PFS (mPFS) and median OS (mOS) were nearly doubled in the EV+P arm compared with chemotherapy. The benefit in prespecified subgroups and stratification factors were consistent with the overall population. The safety profile aligned with expectations and no new safety signals observed. EV treatment-related adverse events of note were skin reactions, peripheral neuropathy and sensory events.

Dr. Yohann Loriot (FR) presented on the THOR trial, stating that in the trial that erdafitnib significantly extended the OS in patients with advanced/mUC with FGFRalt after prior treatment with anti-PD-(1), with a mOS of 1 year.

According to Dr. Loriot, erdafitnib provided a 36% reduction in risk of death compared to chemotherapy, the OS benefit of erdafitnib was consistent across the relevant subgroups, and it offered significantly longer PFS and greater objective response rate (ORR) compared to chemotherapy.

Dr. Loriot: “This phase 3 THOR study supports the clinical efficacy of erdafitnib as the standard of care option for patients with mUC with FGFRalt after anti-PD-(L) 1 treatment, and the OS benefit of erdafitnib in patients with mUC with FGFRalt supports molecular testing for FGFRalt in all patients with mUC”.

You can watch a webcast recording of the full presentations on the EMUC23 Resource Centre.

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In his lecture ‘Image guided LN dissection’, urologist Prof. Tobias Maurer (DE) used a case study to conclude that there is no proof that image-guided LN dissection facilitates cure for prostate cancer as of yet. “PSMA-radio-guided surgery may be considered in 1-2 atypical located suspicious LNs (lymph-nodes). Multimodal therapy is very likely in patients with PSMA PET positive LNMs (lymph-node metastases), but when you need adjuvant therapy, why not upfront?”

According to Prof. Maurer, there are five image-guided LN dissection techniques: Cognitive image-guided LN dissection, sentinel-LN dissection, intraoperative PSMA-PET specimen PET/CT (new), PSMA-radioguided surgery and PSMA-fluorescence-guided surgery (new).

The role of SABR and MRI-guided adaptive RT

In her lecture ‘MR-guided radiotherapy and SABR’, Dr. Alison Tree (GB) stated that stereotactic body radiotherapy (SBRT/SABR) is likely to be the future of high-risk prostate cancer care (PACE-B trial), and MR-linac (MRI-guided linear accelerator) will enable opportunities to test new paradigms of cure.

In her definition, SBRT is a treatment given in 1-5 sessions (rather than 20-40). A larger dose is given at each treatment (fraction), with a high dose given around the tumour, with a fast dose that ‘fall off’ around the tumour. Dr. Tree indicated that if you get the dose accurate enough, the side effects may be eradicated. Trial results have shown this for the bowel, but not in the short term for the prostate yet, although after five years there is no difference.

According to Dr. Tree, the three key advantages of MRI-guided adaptive RT are imaging resolution, intrafraction motion monitoring and correction, and changing the dose whenever the anatomy changes. “Fundamental change in how we deliver radiotherapy. We need ‘margins’ because the prostate can swell, the prostate can move, the patient could wriggle, and the cancer can change”.

Complexities of systematic treatment for high-risk PCa

Covering neoadjuvant treatment, adjuvant treatment and ongoing clinical trials, medical oncologist Dr. Sara Merler (IT) presented “How systemic treatment should be used for men with high-risk localised prostate cancer in 2023”.

According to Dr. Merler, the EBRT + long term ADT remains as the first standard option with the duration of ADT of 18 to 36 months. The addition of abiraterone/prednisone in patients who meet the STAMPEDE high-risk definition shows the landscape is rapidly evolving. She stresses that the added value of multimodality treatments, including radical prostatectomy, is not known, and multi-toxicities, as well as costs must be considered.

“When looking at the trials, the definition of high-risk differs. We need to find a consensus for the definition, a possible re-classification in N+ and/or M+ with new imaging (PET-PSMA).”

Dr. Merler concluded with a comment about bone health and osteopenia/osteoporosis prevention and the risk in elderly patients.

You can watch a webcast recording of the full presentations on the EMUC23 Resource Centre.

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Taking place on day one of EMUC23 in Marseille, the symposium was co-chaired by Prof. Maurizio Colecchia (IT), Prof. Kerstin Junker (DE) and Dr. Gladell Paner (US).

Dr. Markus Eckstein (DE) presented his lecture ‘Molecular differences between primary bladder tumours and metastasis and differences in PDL – 1 expression’. He began by explaining the metastatic evolution from stem(s) to branches. “Tumour properties driving clonal evolution include genetic alterations, cell cycle alterations, DNA-repair alterations, cell mortality and EMT/MET.”

He stated that metabolic effects include the environment such as oxygen, nutrients and hormones. Immunological selection pressure includes immune invasion and immune suppression. Niche properties include nutrient/oxygen supply, immune surveillance (liver, brain and bone), and stroma conditions.

With this highly complex interaction between many cell populations and environmental factors, Prof. Eckstein concluded with the question, “Can we go on testing biomarkers in primary tumours for precision oncology?”

Middle-grade NMIBC?

A case study was shared by pathologist Prof. Colecchia (IT) during his lecture ‘Proposal of a new grading in non-muscle invasive bladder cancer’. He took a deep dive into explaining how the grading recommendations for NMIBC could be improved, as well as the reproducibility of the grading system.

Prof. Colecchia sited several studies that tried to correlate outcomes between heterogeneous grades. “There were different thresholds for the fraction of high-grade cells. If it is a <10% of a high-grade tumour cell, there was no change in clinical outcomes of low-grade carcinoma. Distinction between low-risk and intermediate-to-high-risk carcinoma can provide the basis for adjuvant intravesical instillation and regimen of BCG (Bacillus Calmette-Guerin) [with its significant side effects].”

Prof. Colecchia reported that in 2022, the WHO proposed criteria for reporting papillary tumours as high-grade as long as the high-grade component represents >5% of the tumour. Moreover, tumours with <5% high-grade component should be reported as ‘low-grade with <5% high-grade component’.

To watch the full presentation, visit 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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Urologist Prof. James N’Dow began his presentation on OPTIMA highlighting the overall project goal, “Every patient should have access to the most up-to-date individualised treatments and innovative therapies.” He stated that the idea of OPTIMA is to strengthen shared decision-making by using dynamic computer-interpretable guidelines (CIGs), innovative broad data access and AI-driven technology and tools, with a specific focus on prostate cancer, as well as breast and lung cancer. OPTIMA’s vision to establish a data catalogue with large-scale, structured and unstructured real world datasets that can be shared on a platform, with a guideline decision-support toolset that can be regularly updated.

“After being chairman of the EAU Guidelines Office for seven years I can see that evidence gaps are not filled fast enough with high quality randomised clinical trials, and evidence-based medicine is evolving to include real world medicine. Real world data / real world evidence (RWD/RWE) analytics and artificial intelligence will be the real game changer.”

The challenge of information overload

In his presentation “Sense-mining the literature: How artificial intelligence can help us master the evidence”, Dr. Bob Schijvenaars (NL) talked about the development of a new platform to share literature.“ In a survey we conducted, we found that 60% of oncologists and 80% of urologists reported that they were not able to easily find answers in literature for complex questions on treatment of prostate cancer. The reasons included that people didn’t know the best methods for searching, searches didn’t return relevant material, or weren’t accessible. Time was also a big factor. We decided to find a solution to address the challenge of information overload.”

“We started two research projects to help develop an AI framework to capture semantics and enhance searches with the ultimate aim to have a question-answering system. Project one was named BRAF and we extracted test- and mutation rates. The other project was called INSIDE, which distinguished sequencing, combo-therapy and occasional mentions.”

According to Dr. Schijvenaars, the sequencing was a success and he believes domain-specific AI can address the information overload by capturing semantics. This will save time and avoid users to construct complex search queries. Sequencing is just one example of the framework. Other capabilities include targeted data extraction and guidelines generation.

“The next step will be to further explore additional relations and improve the accuracy of the system. The end goal is getting the relevant information and saving time”, concluded Dr. Schijvenaars.

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PEACE-1

Oncologist Dr. Alberto Bossi (FR) presented the latest trial findings. “Adding abiraterone to ADT+docetaxel significantly improves rPFS (radiographic progression-free survival) by a median of 2.43 years in men with de novo metastatic prostate cancer. Overall survival is also improved with a 25% reduction in the risk of death, even when 84% of mCRPC (metastatic castration-resistant prostate cancer) men in the control group receive at least one life-prolonging treatment.”

“This benefit translates in a median lifetime gain of more than 1.5 years for men with high-volume metastases (5.1 vs 3.5y). Toxicity was as expected, with no apparent synergistic side effects from this combination. For the future, there needs to be results for radiotherapy and local symptoms.”

Further exploring the topic, Prof. Nicolas Mottet questioned the benefit for everyone. He pointed out that even though quality of life (QoL) levels out equal after 48 weeks when adding DXL, there is initially a significant decrease in QoL for the first 24 weeks with both physical and social functioning. He added that direct efficacy comparison between trials was highly questionable and there was no added value to the triplet option.

Prof. Mottet concluded “This is the first time you will see the new 2023 EAU-EANM-ESUR-ESTRO-ISUP-SIOG-ESUR Guidelines, which recommends to offer docetaxel only in combination with abiraterone or darolutamide in addition to ADT to patients with M1 disease and who are fit for docetaxel and are willing to accept the increased risk of side effects.”

OpeRa

Prof. Marc-Oliver Grimm (DE) reported on the first randomised controlled trial (RCT) there has been for comparing OPN (open partial nephrectomy) and RAPN (robot-assisted partial nephrectomy) in intermediate/high complexity renal tumours. “The OpeRa trial represents a real-world example of conducting an randomised clinical trial. It was underpowered due to slow recruitment over the COVID-19 period which resulted in a premature termination, as well as the implications of a differential withdrawal period prior to treatment of 5% for RAPN and 23% for OPN.”

“The results showed a significantly lower procedure-related complication rate with RAPN compared to OPN over 30-days. Overall there were fewer high-grade events, even in higher complexity tumours and patients reported significantly less pain with RAPN. There was a significantly lower skin-to-skin operative time required with RAPN and a 1-day shorter hospital stay time with RAPN, which is significant in terms of cost.”

As a discussant, Prof. Axel Bex (GB) congratulated the investigators on this trial as they are difficult to undertake and agreed with the benefits of quicker recovery time and less time in hospital. In his rebuttal, he questions the clear lack of equipoise among the surgeons and patients. He added “In protocol v2, the experience of surgeons has been downgraded to >10 RAPN/OPN in 12 months which is low. Significant imbalances in BMI and anticoagulants are difficult to explain by randomisation.”

According to Prof. Bex, the trial was also statistically underpowered to investigate the primary endpoint and leans heavily on secondary endpoints which are all difficult to interpret due to the small numbers.

Adjuvant therapies in high-risk RCC

Dr. Javier Puente (ES) presented an overview on the different trials for adjuvant therapies in high-risk RCC including Keynote-564, CheckMate 914, INmotion010 and PROSPER. He stated that adjuvant pembrolizumab has shown improvement in disease-free survival relative to placebo in patients at intermediate-high, high and M1 no evidence of disease (NED) risk groups.

“The INmotion010 trial and Checkmate 914 (Part A) have failed to demonstrate an improvement in DFS (disease free survival), and in the PROSPER trial, perioperative nivolumab did not reach the primary endpoint of RFS (recurrence free survival).” He added that well informed patient selection will be the key.

Clinical Oncologist Robert Huddart (GB) also shared results from the TRISST trial, with discussant Radiologist Harriet Thoeny (CH).  You can view the full presentation of Plenary Session 5 via the EMUC22 Resource Centre

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