8th ESOU challenges well-entrenched approaches in PCa therapies

21 January 2011

With a record number of more than 900 registrations and a high attendance rate, the 8th EAU Section of Oncological Urology (ESOU) opened today in London (UK) with the first-day session tackling issues that examine and challenge some well-established approaches in prostate cancer (PCa) treatment.

“In cancer prevention, patients need to be more aware of lifestyle improvements such as proper diet and regular exercise, and the ill-effects of smoking. But equally important is the crucial role that early diagnosis can contribute to the prospect of long-term survival amongst patients,” said Prof. Sir Mike Richards, the UK’s Department of Health’s National Cancer director in his keynote address.

Richards said urological malignancies collectively constitute the commonest tumour group, accounting for a significant workload in the work of cancer specialists. He also mentioned a UK survey wherein UK patients noted an improvement in cancer care compared to a decade ago. He, however, added that “a great deal still needs to be done” to further boost the quality of healthcare. With prostate cancer as topic in the opening session, other issues in renal, bladder and testis cancers will be taken up in the next two days.

In his lecture on the role of 5 alpha-reductase inhibitors (5ARIs) in chemoprevention, Prof. P. Hammerer (Braunschweig, Germany) said that “there is a rationale for the use of dietary factors and 5ARIs in prostatic disease.”

“5ARIs reduce the risk of being diagnosed with prostate cancer among men who are screened regulalry for prostate cancer,” Hammerer said in his concluding remarks. “The overlap between BPH and prostate cancer may allow a more unified approach to managing these conditions, with 5ARIs having a central role,” he said while noting that “… information is inadequate to assess the effect of 5ARIs on PCa or all-cause mortality.”

He also mentioned that although conclusive evidence is still limited, the current data indicate that a low-fat, high fibre diet that is also complemented with dietary habits that avoid high energy intake, excessive meats and dairy products may contribute in reducing the incidence of PCa.

Regarding the role of Magnetic Resonance Imaging (MRI) in the detection, localisation and staging of PCa, J. Barentsz (Nijmegen, the Netherlands) described the fundamentals of multiparametic MRI for prostate cancer and gave an overview of various MRI techniques.

“Multiparametic MR imaging may potentially increase prostate cancer detection accuracy in comparispon to T2-weighted MR imaging only. However, future research is needed to confirm initial results,” said Barentsz.

In the first debate session Theo De Reijke (Amsterdam, the Netherlands) took the critical viewpoint on the EAU Guidelines on prostate cancer particularly on the issue whether all margin-positive patients after radical prostatectomy should be given adjuvant radiotherapy. Defending the EAU Guidelines was M. Bolla (Grenoble, France) who said that within the context of a multidisciplinary approach, “adjuvant radiotherapy has to be a part of the tacit contract established between surgeon and the patient, each time the likelihood of a local relapse seems important after radical or conservative procedures…”

He stressed, however, that the strategy should be evidence-based, and noted that for pT2R1pNo patients, post-operative irradiation has “…not provided a gain yet.”

“Outside clinical research a careful clinical and biologic follow-up may be recommended, provided the patient has been informed,” according to Bolla.

Other selected key messages are:

  • “Radical prostatectomy (RP) for the treatment of high risk disease can lead to superior results on overall and cancer specific survival compared to radiation therapy. Therefore, the role of RP for treating these cancers is growing. However, achieving negative surgical margins is an important goal in these cancers and can be achieved by the use of frozen sections during the procedure. Nevertheless, a frozen section is only meaningful in patients who undergo a nerve-sparing procedure…” (M. Graefen)
  • B. Djavan on PSA: Do it earlier (at young age) and repeat it once. Lower the cut-off and observe PSADT and PSAV. The Punglia/Eastham data support the lowering of the PSA threshold to:

1.4 in men aged <60 years (senstivity 0.74, specificity 0.79)

2.1 in men aged >60 years (sensitivity 0.68,specifity 0.70)

By: Joel Vega