Having just returned from the always-stimulating European Association of Urology annual congress, I’d like to share a few impressions.
For starters, it was interesting to see the direction in which the treatment of localized prostate cancer (PCa) surgery is likely headed. I’d like to single out a session that was devoted to focal therapy, with an emphasis on the use of magnetic resonance imaging to pinpoint the exact location of tumors and allow real-time imaging so surgeons can watch as they use various methods to destroy tumors while leaving the rest of the prostate intact.
The studies presented at the session consisted of small series of patients treated with laser ablation, hemiablative brachytherapy, high-intensity focused ultrasound, cryotherapy (for salvage treatment after failed radiotherapy), and irreversible electroporation. The researchers on all of the studies reported promising results. Of course, these focal therapies need to be tested in larger numbers of patients with longer follow-ups, but I left the session with the sense that I was witnessing the beginning of what could be a fundamental shift in the surgical management of localized prostate tumors.
Also evident at the meeting was the ongoing effort to fine-tune various aspects of active surveillance for low-risk PCa and small renal tumors. One study demonstrated that negative second, or confirmatory, prostate biopsies in men on active surveillance for PCa do not rule out grade progression. In a another study, British researchers found that PCa patients with a tumor visible on baseline MRI scans are more likely to experience radiologic progression while on active surveillance than those without a visible lesion. And with respect to kidney cancer, a study found that non-surgical management of small renal tumors is associated with increased mortality compared with either partial or radical nephrectomy.
Lastly, the conference had some important new advances related to PSA screening. For example, one study demonstrated that the benefit of PSA screening in terms of PCa detection lasts for up to nine years after screening cessation. The study looked at 13,423 men in the European Randomized Study of Screening for Prostate Cancer who reached the screening upper age limit of 69 years. In 1995, 6,449 of these men had been randomized to an intervention arm (invited for biennial PSA screening) and 6,974 were in a control arm (not invited for biennial screening).
(News reports on these and other studies presented at the conference are available on our website and will appear in future issues.)
All in all, it is clear from the meeting that researchers are making significant headway in the understanding of urologic diseases and their management.