Leading European experts active in imaging and image guided treatment in urology gathered in Berlin in late October to discuss the latest advances and applications in the field. The 2nd International Meeting of the EAU Section of Imaging (ESUI) met many of our expectations and more. All the presentations were of excellent quality which resulted in excellent interaction and discussion between speakers and the audience throughout the meeting.
Additionally, we were able to hold an interesting, informative and productive round table with the industry on the first day of the meeting, which revealed that both sides, the urologists and equipment developers, need a more intense communication and interaction with each other We believe that this discussion is the first step to improved communication to which we will strive for in the future.
The meeting generated a number of interesting conclusions and the delegates went home with a set of actionable take-home messages:
Imaging and diagnosis for prostate cancer
One of the main conclusions with regard to imaging and diagnosis for prostate cancer was the fact that well-designed multicentre trials are necessary for all of the currently available imaging tools for PCa such as elastography, contrast enhanced ultrasound, ANNA/C-TRUS, HistoScanning and MRI. In addition, everybody agreed that standardisation, training and quality control is mandatory and essential before MRI could reliably be used at a large scale in daily practice outside of specialised research centers. Efforts in this direction are essential and urologists should urge radiologists to apply the currently available standards.
Innovative imaging of the bladder and the urinary tract
Here, many fascinating techniques are available and more are in development, and at the same time it is clear that further research is necessary. Photodynamic imaging is becoming more frequently implemented in the daily practice and data strongly supports this tendency.
Imaging based treatment of small renal masses
Imaging is readily available and used for treatment of small renal masses. However, tissue characterisation and follow up after focal therapy with imaging only is still an issue.
Future tools for imaging in urology
This discussion was certainly one of the main highlights of the meeting. Many new technologies are emerging, and several are not far from clinical use, for example molecular imaging for contrast enhanced ultrasound and optical coherence tomography (OCT) imaging. The experts agreed that image fusion will improve surgery in the future due to enhanced reality, especially in robot-assisted surgery and currently, preliminary systems are in development.
Imaging and treatment of prostate cancer
The entire urological community is eager to get their hands of reliable imaging techniques for prostate cancer as it has the potential to revolutionise the treatment. So far, there are several promising technologies available, but none of them provides a “perfect performance”. We have to keep in mind that depending on the chosen treatment modality, different priorities and information are demanded from imaging:
- Radical prostatectomy: local extension
- Active surveillance: volume, grading, follow-up
- Radiotherapy: local extension, treatment planning and monitoring, follow-up
- Focal therapy: localization, extension, treatment planning and monitoring, follow-up
How I do it
How I do it sessions were very well received by the delegates. The presentations provided state of the art procedures for prostate and kidney biopsy with very helpful information for daily practice. All talks offered a good insight into how the different techniques work in practice.
The meeting held a successful poster session, with the prize for the best poster going to Dr. L. Budäus from Hamburg (DE) for his paper “Identification of apparent-diffusion-coefficient (ADC) cut-offs during DWI-MRI in prostate cancer lymph node metastasis: Implication for daily clinical practice”. Overall the quality of abstracts can to be commended and we hope that our future meetings will attract even more talented urologists, interested in the field of imaging.
Topics for the future
The next ESUI meeting is scheduled for the autumn 2014. There are many topics that we will need to explore in the future. The results of the much expected studies for imaging for prostate cancer will be available by then, such as the ESUI 12/01 HI-RTE study, which will compare the value of real time elastography in the diagnosis of prostate cancer in a multicenter setting.
Future tools will also play a large role in the next meeting, and we are awaiting some very promising solutions in this field.