EAU18 – New agents and imaging techniques to improve PCa management

There is a range of new agents, molecular markers and improved imaging techniques that over the coming years will help doctors to further optimise their management of prostate cancer patients, particularly those with advanced or high-risk disease.

Yesterday during the 5th European School of Oncology (ESO) Prostate Cancer Observatory, a panel of prostate cancer (PCa) specialists presented their expectations for promising medical approaches that aim to boost the current management of PCa.

The multidisciplinary presentations covered new developments and forecasts for research, surgery, active surveillance, imaging, pathology, and medical oncology. The perspective and concerns of patient groups were also discussed by Prof. Louis Denis (BE) as a representive for these groups.

“My expectations for 2018 and next year are further results from STAMPEDE and the potential changes in the standard of care for metastatic hormone-naïve prostate cancer (mHNPC) patients,” said medical oncologist Dr. Ananya Choudhury (GB) who gave the view from her discipline.

Choudhury added that results are awaited from sequencing and combination studies. She mentioned hormonal agents being tested in trials such as SPARTAN (Apalutamide), PROSPER (Enzalutamide), STAMPEDE/LATITUDE (abiraterone) as well as STAMPEDE, which is testing the combination of abiraterone and enzalutamide.

Giving the urological perspective on active surveillance (AS), Prof. Karim Touijer (US) stressed its importance and noted that its increasing use necessitates educating the physician in order to provide better counselling to patients. Touijer stated that it is important is to collect more information on AS and to reassure the patient about future treatment options.

Prof. Steven Joniau (BE), who co-chaired the session with Prof. Riccardo Valdagni (IT), said: “For me, the session showed that we need to better understand the disease with the aid of the many tools we have now such as PSMA, MRI and others, in combination with the standard tests such as PSA. Tools such as PSA still have their use despite the entrance of new methods. It is important to avoid over-treatment and instead focus on the detection and treatment of high-risk cancers.”

Joniau reiterated Touijer’s key message as he stressed the importance of AS to avoid over-treatment of low-risk PCa.

Dr. Ivo Schoots (NL) discussed prostate MRI and its diagnostic accuracy, noting that a limitation of MRI is disagreement among radiologists. “There are now proposed adjustments to the PIRADS text,” said Schoots. “Looking back, to 2017, prostate MRI shows maturation with its strength and limitations.”

Prof. Rodolfo Montironi (IT) discussed developments in pathology such as the update of PCa grading, intraductal carcinoma of the prostate, the routine molecular markers used by pathologists with multiple clinical purposes, and the potential of liquid biopsies such as urine and blood.

“Voided urine is increasingly being used for urological cancer diagnostics by measuring cancer-associated proteins, RNA transcripts and methylation,” said Montironi.

Article by Joel Vega