Looking ahead in PCa management
The “8th ESO Prostate Cancer Observatory: Innovations and care in the next 12 months” was a highly educational session showcasing predictions by experts from diverse fields in prostate cancer (PCa) management. This Special Session was chaired by Prof. Ursula Vogl (CH).
In Prof. Philip Cornford’s (GB) presentation, “The urologist’s perspective on active surveillance”, he stated MRI is useful to select patients for active surveillance and that MRI might replace biopsy for men with ISUP 1 disease or PIRADs 1-2 lesions.
According to Prof. Cornford, “Men with low risk prostate cancer don’t need treatment, so try not to give them side-effects unless you have data to suggest an improvement in a significant clinical endpoint such as development of metastatic disease or survival.”
In his lecture “The medical oncologist’s perspective”, Dr. Ricardo Mestre (CH) stressed that consensus recommendations for the evaluation and management of PSMA-PET only mCSPC patients is an urgent unmet clinical need.
“All the practice-changing evidence available for the treatment of mCSPC is based on conventional imaging. PSMA-PET/wbMRI has allowed better detection of metastatic lesions and can impact in treatment decisions.”
According to Dr. Mestre, systematic therapy with chemotherapy (Docetaxel) or Abiraterone or ARTA (Enzalutamide, Apalutamide) or combinations (Darolutamide+Docetaxel, Abiraterone+Docetaxel) with ADT has been demonstrated to improve outcomes. Treatment of the primary tumour also has a role in oligo-metastatic disease. Further prospective data are needed to best select patients most likely to benefit from a given therapeutic approach.
Prof. Eva Compérat (FR) stated that PCa histology is still very much based on morphology, in her lecture, “The pathologist’s perspective”. According to Prof. Compérat, it is important to be cautious not to include IDC-P and cribriform patterns into active surveillance because these very aggressive forms and people die more often. Quality and care when assessing a patient’s pathological report is vital. Artificial Intelligence may help in the future, but it will take 10-15 years to have really good data. Other factors include the infrastructure, lab and routine system and the costs.
Dr. Stefano Fanti (IT) suggested that PSMA PET/CT has higher detection rates than any other imaging modality, especially in patients with low PSA values. In his presentation “The imaging specialist’s perspective on PSMA-PET/CT”, he expressed that this imaging is really cutting edge.
“We should be brave enough to abandon some of the old imaging, PSMA-PET/CT is not just the future, it is here right now. The images you are looking for come out well and finding the hot spot is very simple.”
He questioned why bone scanning is still used, because in older people it is not that accurate because more hot spots are shown with inflammation, for example. According to Dr. Fanti, PSMA-PET/CT is now recommended in both the EAU guidelines and the ASCO Guidelines.