Plenary Session 5: Update and controversies in prostate cancer

15 April 2014

“The 29th EAU Congress has been a success. Particularly the attendance of countries beyond Europe was very high, for example Latin American countries like Brazil and Venezuela,” said Prof. Per-Anders Abrahamsson (Malmö, SE) in his opening remarks during the last Plenary Session of this year’s event. The session was titled Update and controversies in prostate cancer, and it dealt with all aspects of the PCa, from genomic alterations to risk stratification.

Prof. Thorsten Schlomm (Hamburg, DE) presented on genomic alterations and early-onset prostate cancer. He noted that “the very low number of recurrent gene specific genomic events raises the question of other fundamental molecular mechanisms playing a particularly relevant role in prostate cancer.” For example, chromosomal deletions are highly recurrent, more so than any other molecular event in PCa. Moreover, PCa aggressiveness is connected to the total amount of deleted chromosomal material. Yet, the nature of the deletions qualifies them for promising new therapy targets, and the outlook is promising. The costs of sequencing of the human genome are going down significantly, and this can lead to improved manners of identifying patients who can be recommended active surveillance. In sum, clinical practice is being changed by the developments in comprehensive molecular data.

Up next was Prof. Jack Cuzic (London, GB), who presented the consensus statement on early detection and prevention of prostate cancer. Among the risk factors he presented, it could highlighted that, while smoking increases the risk for aggressive cancer 2-fold, it has not been found to have any effect for indolent cancers. Also, that weight risks are more complex than generally thought, since increased BMI is associated with a higher rate of advanced prostate cancer, but it can also be linked to a lower level of localised disease.

He then presented the results of five screening trials completed so far, none of which showed a reduction in PCa deaths, and three of which did not meet quality standards. It was noted as well that results differed significantly between the North American (PLCO) study, and the European (ERSPC) one, without a clear indication as to why this would be the case. He closed his intervention with a research agenda including, among other measures for evaluation and refinement of PSA screening strategy, management of cases detected by screening, and therapeutic prevention.

Dr. Jonas Eigar Hugosson (Göteborg, SE) presented the results of the European Randomised Study of Screening for Prostate Cancer (ERSPC), which has been accepted for publication by Lancet. Results were mixed. The study showed that opportunistic PSA screening is less effective than organised PSA screening and is associated with more overdiagnosis. It also showed, however that PSA-based screening significantly reduces prostate cancer mortality, and that screening should not start too late in life. However, the effect from PSA testing seems not to last as long as expected.

The eURO Auditorium was full, with an audience eager to get more information during the plenary half-day session.

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