4th ESO Prostate Cancer Observatory offers 12-month forecast
Prostate cancer specialists should be aware of several key developments: encouraging results on the use of PSMA-PET, upcoming genomic studies, and an evolving reassessment of Gleason pattern 4 which could change risk classification and has serious clinical implications.
At the same time, these new developments should always take into account the quality of life of prostate cancer patients.
These topics and more were presented yesterday at the 4th ESO Prostate Cancer Observatory, onwas special sessions held at the 32nd Annual EAU Congress in London which drew a large audience. Chaired by Dr. Riccardo Valdagni (IT), coordinator of the European School of Oncology’s Prostate Cancer Programme, and EAU Adjuncty Secretary General for Education Prof. Hendrik Van Poppel (BE), the Observatory was held under the auspices of Europa Uomo, the European Prostate Cancer Coalition.
Valdagni: “The Annual EAU Congress is the perfect venue for our observatory. Our goal is always to talk about the true state of the art of that year.” The session featured the perspective of researchers, urologists, imaging specialists, pathologists and both radiation and medical oncologists.
“We ask these experts, who are highly specialized in their respective fields, for their forecast for the future of prostate cancer treatment. There are so many new drugs, new technologies, and emerging genetic information. We would like their opinion, not only evidence-based, but their personal views and perspectives on what will be changing for prostate cancer treatment in the near future.”
Innovations in surgery
Speaker Prof. Derya Tilki (DE) provided the urologist’s view on surgery and focused on how new imaging technologies will influence surgical treatment, specifically PSMA imaging and its impact on salvage lymph node dissection.
“Emerging data suggests that surgery may represent an important therapeutic modality in the management of oligometastatic nodal recurrence after local therapy of PCa, but prospective randomized trials are lacking,”said Tilki. “Identification of patients who will benefit from surgical treatment largely depends on imaging, which at the moment still may underestimate the load of metastases. PSMA-radio-guided surgery for detection of PCa recurrences may become more routinely used in the next 12 months.”
“Although imaging is improving, it remains our task to evaluate the clinical implication. We do not know at present whether improved imaging leads to a survival benefit, or might just be another source of over-diagnosis and overtreatment,” Tilki cautioned.
The patient
It was precisely the issue of over-diagnosis and overtreatment that Prof. Louis Denis (BE) made a point of warning the audience during his talk. Speaking from the patient’s perspective, Denis stressed three crucial points for good clinical PCa practice: first, to treat the patient first, and then his cancer; second, that there is no definite relation between LUTS and curable PCa; and finally that the serendipity of focal, indolent PCa leads to both over-detection and over-treatment in 50% of the patients.
Areas for improvement in the next 12 months were characterized by Denis as optimizing performance of validated risk prevention tools and using big data to overcome multivariable aspects when deciding on best treatment. Decisions on survivorship, life goals and non-medical decisions should be shared between patients and physicians to ensure patient-centered management.