EMUC19: What to do when faced with a nightmare PCa case

15 August 2019

Imagine a treatment strategy not working on your patient. The situation escalates and the patient suffers from complications. What do you do? The Nightmare Session: It could happen to you… at the upcoming 11th European Multidisciplinary Congress on Urological Cancers (EMUC19) will provide proven strategies in preventing and addressing prostate cancer (PCa) challenges.

The session will feature insights of esteemed urologist Dr. Rafael Sanchez-Salas (FR) who specialises in intervention and surgery; and  prominent radiooncologist Prof. Dr. Thomas Wiegel (DE). The renowned specialists will provide a binary perspective on the patient cases.

“The session’s objective is to show where things can go wrong especially with alternative treatment, and how to approach that optimally,” stated Prof. Dr. Arnulf Stenzl (DE), EAU Adjunct Secretary General – Executive Member Science.

Prof. Stenzl and Dr. Cesare Cozzarini (IT) will chair the session, which is part of the popular Nightmare Session series introduced at the EAU’s annual congress held in London in 2017.

The EMUC19 Nightmare Session will show varied perspectives and outcomes of opting for an intervention (e.g. focal therapy) or a radiooncological treatment. “It is interesting for both the radiooncologists and urologists to know which treatment addresses and solves the case,” said Prof. Stenzl said. “It is also important to know where the problems and pitfalls lie in each treatment possibility.”

The cases

Each discussant will present patient cases where treatment were done with curative intent.

“The cases in the session represent typical clinical situations commonly feared by clinicians. For example, a patient was just treated with curative intent with either radical prostatectomy or radical radiotherapy. However immediately after, the clinician realises that metastasis was already present even before the patient underwent radical treatment. Unfortunately for some reason, this was not initially recognised. How should the clinician approach this situation? This is the type of cases that the Nightmare Session will highlight,” stated Dr. Cesare Cozzarini.

Radiooncologist viewpoint

“The objective of my lecture is to inform urologists and radiation oncologists about a significant pitfall in the treatment of patients with locally advanced PCA,” explained Prof. Wiegel. “In locally advanced PCa, one standard is radiation therapy (RT) plus two to three years of Luteinising Hormone Releasing Hormone (LHRH)-analogue; the increase of overall survival of about two years is proven in phase III trials.”

Prof. Wiegel will present a case wherein a patient conformed to start androgen-deprivation therapy (ADT) treatment. Then after 50 Gray (Gy), the prostate-specific antigen (PSA) was controlled and showed a significant increase in contrast which was expected. However according to the patient, he had not received ADT due to fear of the side effects concerning potency. “This has been detected with the PSA and if it wasn’t, the treatment was not standard in combination with the clear early progression of the disease,” said Prof. Wiegel.

During the Nightmare Sessions at EMUC19, Prof. Wiegel and Dr Sanchez-Salas will share more valuable insights and advice.

About EMUC19

EMUC19 is a frontline, multi-disciplinary congress designed to encourage relevant discussions on innovative treatment, the limits of standard therapies, and the impact of new research outcomes. Its reputation as prime European platform for professional and scientific exchanges in genitourinary oncology has been well-established throughout the years.

The congress brings together esteemed specialists and healthcare professionals from various disciplines, thanks to the collaborative efforts of the European Society for Medical Oncology (ESMO), the European SocieTy for Radiotherapy & Oncology (ESTRO) and the European Association of Urology (EAU).

EMUC19 will take place on 15-17 November 2019 in Vienna, Austria. For more information about the congress and how to join, explore the EMUC19 website.

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