EAU17: EAU – CAU meeting delivers new approaches

The joint meeting of the EAU and the Confederación Americana de Urologia (CAU) held yesterday focused on varied topics ranging from new insights on upper tract tumour conservative management, comparison of radical prostatectomy (RP) and radiation therapy (RT), robotic surgery in cystectomy, to focal therapy, and many others.

This Urology Beyond Europe session kicked off with the presentation of Prof. Alberto Briganti (IT) on RP versus RT for high-risk localised prostate cancer (PCa). He said surgery is the treatment of choice for aggressive PCa because RP allows individualised treatment, multimodal approach, decrease the rates of over-treatment, and no secondary malignancies for younger and healthier patients.

“In the absence of well-done randomised controlled trials (RCTs), RP should not be compared to RT with hormonal therapy (HT). However, RT + HT does not represent the standard treatment for locally advanced prostate cancer. RP alone can be curative for locally advanced patients,” said Briganti.

According to Dr. Octavio Castillo (CL), robotic radical cystectomy (RRC) remains the “hardest urological operation [to perform] to date”. He said that RRC is technically feasible with acceptable short and immediate term oncological results. There is less blood loss and duration of hospital stay compared to open cystectomy. RRC is equal to open cystectomy in terms of extirpative, oncologic and reconstructive ways. Routine use of RRC although remains to be proven, intracorporeal urinary diversion will make the difference.

On his lecture on the conservative management of the upper tract tumour, Dr. Alberto Breda (ES) said that tumours less than 2cm in size can be treated with endoscopy. Digital RIRS (retrograde intrarenal surgery) should be performed to diagnose and treat these tumours, and to treat low-grade tumours with laser. He also mentioned confocal microscopy, a tool that can give intraoperative diagnosis of a cell instead of a tumour. Breda said, “This is an in-vivo procedure that, when this technology is applied to a tumour, you are able to see whether the cell has a lot of mitosis, an indication of a high-grade disease.”

Dr. Rafael Sanchez-Salas (FR) cited studies with outcomes that included Focal Therapy (FT) as a safe and effective treatment for low-risk PCa. Sanchez- Salas said improved imaging has drastically changed the PCa pathway in terms of diagnosis, treatment decision and planning, and outcomes control. Selection for MRI and biopsies depend on disease and patient factors.

“FT therapy trials for PCa are at the early stage of clinical development. More clinical evidence is needed to further enhance PCa treatments,” concluded Sanchez-Salas.