ESO Observatory features forecasts in PCa management
The “6th ESO Prostate Cancer Observatory: Innovations and care in the next 12 months” showcased predictions by experts from diverse fields in prostate cancer (PCa) treatment.
Chaired by Prof. Dr. Jeroen Van Moorselaar (NL) and Mr. John Dowling (IE), the session was introduced with the lecture “The urologist’s perspective on focal therapy”. Prof. Dr. Roman Ganzer (DE) discussed ongoing trials with results to look forward to, such as the multicentre study “MRI/US Fusion Imaging and Biopsy in Combination with Nanoparticle Directed Focal Therapy for Ablation of Prostate Tissue”; the Partial prostate Ablation versus Radical prosTatectomy (PART) study; and the Robotic Surgery After Focal Therapy (RAFT) trial.
In his presentation “The urologist’s perspective on surgery”, Prof. Markus Graefen (DE) made several predictions: the role of radical prostatectomy (RP) as the first line treatment option in advanced PCa will increase; neoadjuvant androgen-deprivation therapy (ADT) might need reconsideration; cytoreductive RP will become routine; and salvage RP after failure of focal therapy will be further explored.
According to Dr. Roderick Van Den Bergh (NL), active surveillance (AS) should be the standard option, reduction in the variation in the AS use is needed, and AS should be standard part of screening policies. In his lecture “The urologist’s perspective on active surveillance”, he stated, “We need to also focus on the timing of treatment, not only its avoidance. We need wider inclusion, targeted biopsy risk stratification, and a personalised approach.”
Dr. Olivier Rouvière (FR) recommended magnetic resonance imaging (MRI) before any prostate biopsy. In his presentation “The imaging specialist’s perspective on MRI”, he predicted that risk stratification will be used to determine who should undergo a biopsy after MRI and that the role of systematic biopsy will gradually decrease. In addition, Dr. Rouvière forecast that obtaining a substantial number of targeted cores from each lesion will remain necessary due to the imprecision of the MR/US fusion methods, and that certification of radiologists and the use of quantitative MRI will improve the reproducibility of interpretations.
In his lecture “The pathologist’s perspective”, Prof. Dr. Ferran Algaba (ES) shared his insights on accurate pathology wherein not all pattern 4, pT2a, pT3a, and positive margins are the same. He also recommended the inclusion of simple molecular pathology, as easy molecular markers can help some patients. Prof. Algaba added that in terms of reproducible pathology, the aim is to improve the pathology image base for standardisation.
According to Dr. Alberto Bossi (FR), genes are crucial in patient profiling. During his presentation “The radiation oncologist’s perspective” he said, “The [treatment] landscape is ready to use genetic profiling for daily decision-making for patients undergoing radiotherapy.”
In her lecture “The medical oncologist’s perspective”, Prof. Silke Gillessen Sommer (GB) shared her expectations for the next two years. Androgen receptor (AR)-antagonists will be a new option in addition to androgen-deprivation therapy (ADT) for metastatic castration-sensitive PCa. In non-metastatic castration-resistant prostate cancer (nmCRPC), treatment with AR-antagonists will be standard for the majority of patients with a short PSA doubling time (PSADT). For mCRPC, precision medicine will become a reality. However, the costs and availability of the above-mentioned drugs will be an issue.
During his presentation, “The andrologist’s perspective”, Dr. Maarten Albersen (BE) anticipated more AS is for improvement of preservation of sexual function in 2019; and more hypofractionation without increased sexual side effects. He added that there would be an increased awareness of and lower threshold in offering therapy for sexual dysfunction.
On behalf of Mr. André Deschamps (BE), Mr. Dowling discussed the three pillars in PSA screening in the lecture “The patient’s perspective”: patient awareness, PSA-led screening with risk stratifications and parameters, and treatment should be carried out in multidisciplinary centres.
Prof. van Moorselaar (NL) and Mr. Dowling (IE) gave insights of what urologists and patients can expect in Prostate Cancer treatment in this video interview here.