Determining disease stage and progression in metastatic prostate cancer (PCa) and a careful consideration of individual patient characteristics are among the key issues that urologists should keep in mind in patients with advanced prostate disease.
These are among the many issues up for discussion at the upcoming EAU Update on Prostate Cancer (PCa17) to be held in Vienna on September 15 and 16. A new meeting organised by the EAU, the aim is to provide a comprehensive update coupled with practical learning insights on the various medical and surgical issues in prostate cancer treatment.
“The most important is to define the disease whether it is low or high-volume metastatic disease) and the aspects which are patient-focused,” said Prof. Axel Merseburger (DE) one of the resource speakers who will examine treatment for hormone-naïve metastatic disease. “Besides that, and according to current guidelines (e.g. EAU prostate cancer guideline 2017), radical prostatectomy is not a recommended treatment outside clinical trials.”
Doctors often encounter dilemmas in treating patients with late or metastatic disease due to the impact of treatment side-effects on the patient’s quality of life. There are many disease aspects that a physician should balance and carefully consider such as the patient’s status, disease recurrence and the crucial timing of administering medical therapies.
“The key challenges are evaluating and deciding treatment for patients, from treating local disease and up to chemo-hormone therapy. Both treatment options have specific side effects and morbidity or toxicity,” Merseburger said.
At the meeting, the emphasis is to deliver a highly interactive session led by prostate cancer experts who will bring to the discussion their insights, best practices and the lessons learned in actual clinical practice. For an in-depth assessment of challenges, the faculty will break the participants into four groups, with each group alternately focusing on topics such as patient selection for biopsy, using imaging after biopsy and issues in active surveillance.
Each breakout session (which totals to 16 sessions over two days) will be preceded by a comprehensive update on core topics such as diagnosis and staging, local and systemic treatments, patient-centred strategies, and future perspectives in disease management, among others. Results from current research and experience from expert centres will be highlighted by the resource speakers.
Merseburger noted that there are several prospects offered by the development of new drugs and this rapid evolution in treatment has an impact on current protocols.
“I expect a shift towards modern hormonal agents (abiraterone, enzalutamide, apalutamide) which will probably be used and approved in the hormone-naive metastatic prostate cancer setting. In late-stage disease, more precision medicine will be of use such as whole genome sequencing and treating germline or somatic mutations like BRCA1 with, for instance, PARP inhibitors like rucaparib or olaparib, etcetera,” he explained.
Meeting organisers and course directors Prof. Manfred Wirth, Prof. Jens Rassweiler and Dr. Joan Palou have underlined the need for a learning event such as PCa17 since the dedicated meeting is specifically focused on a practical and thorough assessment of to-the-point and incisive recommendations on systemic treatments, castration-resistant disease, drug selection or sequencing and complications management.
Merseburger added: “Participants can expect up-to-date interactive discussions on the topic of prostate cancer. With several new treatment options and new data recently presented, the landscape of treatment and armamentarium will change and that challenge certainly requires a meeting such as PCa17.”