PCa17: Examining challenges in diagnosis and staging

15 September 2017

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With more than 300 participants including faculty and exhibitors, the EAU Update on Prostate Cancer (PCa17) opened in Vienna today, the first in a planned series of educational and interactive compact meetings on onco-urological diseases. Challenges in diagnosis, staging and patient selection were among the issues taken up in the first plenary session.

“This meeting distinguishes itself from other meetings in the way participants will interact with the faculty in a direct and in-depth manner,” said European School of Urology (ESU) Chair Prof. Joan Palou (ES), who welcomed participants together with meeting co-chair Prof. Manfred Wirth (DE).

Palou referred to the breakout sessions which immediately followed the plenary lectures, wherein participants will go through several cases with the lecturers and discuss the finer points, pitfalls and dilemmas. Using digital voting pads, the answers of participants are discussed within the context of current and prospective treatment options.

In the first plenary session on diagnosis and staging, chaired by Professors A. Merseburger (DE) and N. Mottet (FR), prostate cancer screening was discussed by M. Roobol (NL), do’s and don’ts in diagnosis by H. van Der Poel (NL), patient-tailored staging by N. Tunariu (GB), and active surveillance timing and strategies by J. Stranne (SE).

“Screening can save lives, and the PSA test is very useful as an initial risk stratification tool,” said Roobol in her lecture which provided a succinct overview of insights in PCa screening, particularly the role of PSA.

“An elevated PSA alone should not trigger biopsy and stopping screening at low PSA levels is justified,” she added. Moreover, Roobol noted the value of using reflex testing, or repeat PSA tests which help avoid needless prostate biopsies.

Van Der Poel also noted the significance of closely looking into the patient’s family (health) history and of determining PCa deaths, a factor in assessing disease progression and mortality risks. He also expressed a cautious stance regarding targeted biopsies, role of assays, the use of primary (PSMA) PET, and MRI use in low-risk disease.

Presenting the view of radio-oncology, Tunariu stressed the importance of a better understanding of imaging findings and its limitations, the evolving treatment landscape and disease patterns, technology advances such as fusion MRI-US, and balancing patient’s and clinician’s expectations.

Stranne underlined the issue of active surveillance (AS) saying that AS is safe for men with low-risk disease. “AS is most likely safe for men with intermediate-risk PC with GS 3+4 if Gleason grade 4 <5%,” he said.

The first plenary session was followed by case discussions with the participants examining key issues in four groups. The topics were how to perform patient selection for biopsy, performing fusion and systemic biopsy, using imaging after prostate biopsy, and patient selection and follow-up for active surveillance.