Experts tackle issues in prostate cancer diagnostics and treatment

From new imaging technologies, managing high risk prostate cancer (PCa) to the challenges posed by new drugs that present alternatives to standard treatment regimens, PCa experts examined the various ways on how to offer optimal diagnostics and therapy to patients, particularly those with recurring disease.

Chaired by Professors Manfred Wirth (DE) and Didier Jacqmin (FR), Plenary Session 2 presented three debates, three state-of-the-art lectures, and a case discussion which all addressed a manifold of treatment and diagnostic issues in prostate cancer. Despite the emergence of novel techniques, deeply-rooted practices do not disappear overnight and many speakers conceded it may take some time for doctors to move beyond their comfort zones.

“Of all the inhabitants on the planet, none is more resistant to change than humans. Except urologists, of course,” quipped Prof. Kurt Miller (DE) before moderating a debate on chemotherapy for hormone-naïve PCa patients.

The first debate on the role of magnetic resonance imaging (MRI) drew mixed comments although there was agreement that MRI has a role in repeat biopsies. “The greatest benefit of pre-biopsy MRI is found in patients undergoing re-biopsies. Moreover, the main role of pre-biopsy MRI is to detect clinically significant prostate cancer and localize index lesion,” said Dr. Eduard Baco (NO).

To the question regarding the role of pre-biopsy MRI, discussant and radiation-oncologist Prof. Harriet Thoeny (CH) was unequivocal as she confirmed MRI/TRUS fusion-guided biopsies detect more significant PCa with less cores and reduces the detection rate of low-risk cancers. She said the real question is how to keep the costs of MRI economically feasible.

On the chemotherapy debate, Prof. Nicolas Mottet (FR) strongly argued classical hormone therapy will remain with urologists but only if they adapt to changes and learn new tools. “Hormone therapy will not be lost for urologists provided we learn new drugs, recognize major disease changes and be involved in all stages including advanced and final ones,” he said while adding a cautionary word: “A multi-disciplinary team is key for optimal patient care, and the one who knows will take the lead.”

Prof. Thorsten Schlomm (DE), in his state-of-the-art lecture on whether genomics can aid in identifying high-risk disease, said molecular features determine the speed of disease transition. “In the future we will create a molecular speedometer for each patient in order to precisely predict individual patient’s progress.”

The debate on the timing of radiotherapy after radical prostatectomy (RP) also drew sharp commentaries from debaters Prof. Thomas Wiegel (DE) who took up the view for radiation-oncology against that of urologist Dr. Jeffrey Karnes (US). “Why only use one gun when you still have two?” said Wiegel as he insisted there is no overtreatment from adjuvant radiotherapy (aRT) after RP.

Karnes remained steadfast that salvage radiotherapy is a better option since the core goal is to balance survival with adverse effects and costs. “High-level evidence is pending on aRT versus early salvage radiotherapy (eSRT). eSRT is a valid option. Our current evidence of aRT is ‘weak.’ eSRT provides similar survival but less exposure,” added Karnes.