A range of treatment issues were examined during the second part of the day-long session on prostate cancer (PCa) of the 8th EAU Section of Oncological Urology (ESOU) Meeting held today in London, the United Kingdom.
Amongst the topics discussed were active surveillance for PCa, new data in focal therapy, best practices in radical prostatectomy, surgery for high risk localised PCa and the role of immunotherapy for prostate cancer.
Mark Emberton spoke on the areas to improved in active surveillance to prevent under-staging and adverse outcome in PCa. He reviewed the current methods by which urologists assessed risk and identify progression. In his concluding remarks Emberton noted that imaging prior to biopsy will improve precision in terms of validity and reliability. He added that there is also a need for better stratification and more appropriate treatment allocation. “This probably means more active surveillance and tissue-preserving therapies,” said Emberton.
On focal therapy, Samir Taneja provided an overview on developments and said there are still remaining challenges to be worked out. “We have to consider the following questions: should it be image-guidance versus biopsy guidance? What are the methods of follow-up? Should it be biopsy, imaging, biomarkers or both?” He also noted that physicians should re-examine the role of curative intent treatment versus a cost-effective form of risk reduction.
M. Graefen, on the other, discussed the role of frozen section of LN and surgical margins in high risk prostate, localised prostate disease. Amongst his take-home messages are:
* Frozen section of lymph nodes is not meaningful due to its inaccuracy and the fact that patients benefit from RP regardless of the LN status.
* Frozen section of margin status in high risk patients is only useful in the selected group of nerve-sparing procedures; and
* Frozen-section should in general only be done when the results changes the therapeutic approach
Regarding immunotherapy for prostate cancer, G. Kramer gave his views which favour immunotherapy since it has the potential to cure PCa, “….but at an early setting and as part of combination therapy.”
“Currently we lack enough knowledge of the normal and deregulated immune system in the prostate which may interfere with efficacy of immunotherapy,” he said. He also underscored that immunological and clinical monitoring will be a central issue and primary endpoint even more (with no placebo-controlled studies possible in the future).
By: Joel Vega
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